Coosa Dental Associates, LLC

Organization Active NPI General Practice Dentistry · Cedartown, GA

NPI 1326258351 · NPPES record last updated Nov 19, 2007

Key facts

NPI
1326258351
Entity type
Organization (NPI type 2)
Primary specialty
General Practice Dentistry 1223G0001X
License
DN010447 (GA)
Legal business name
COOSA DENTAL ASSOCIATES, LLC
Practice address
109 East Ave
Cedartown, GA 30125-2921
Phone
(770) 748-7736
Fax
(770) 748-4015
NPI assigned
May 22, 2007
Organization subpart
No

Authorized official

Name
Dr. David Bradford Gandy, D.D.S
Title
Dentist
Phone
(770) 748-7736

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Locations

109 East Ave
Cedartown, GA 30125
Phone (770) 748-7736

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry
Group: 193400000X SINGLE SPECIALTY GROUP
1223G0001X DN010447 GA Yes

Addresses

Primary practice location

109 East Ave
Cedartown, GA 30125-2921

Mailing address

109 East Ave
Cedartown, GA 30125-2921
Phone (770) 748-7736

Other providers in Cedartown, GA

All providers in Cedartown, GA · General Practice Dentistry in Georgia

Sources for this page

Verify at the official NPI Registry.