VAN PELT ROCKEFELLER

ROSWELL, GA
NPI1043408792
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy122300000X Dentist
(Licence: GA  DN015157)
Additional Taxonomies225100000X Physical Therapist
(Licence: GA  PT9110)
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2007-10-09
Last Update Date2016-08-09
Business Address
-- VAN PELT ROCKEFELLER DMD
1178 GRIMES BRIDGE RD STE 100
ROSWELL, GA 30075-3935
Phone number: 770-992-7550
Mailing Address
-- VAN PELT ROCKEFELLER DMD
2885 STONECREEK ROAD
SMYRNA, GA 30080
Phone number: 317-529-4047