Provider Demographics
NPI:1316058431
Name:SA, LORENA TADDEI (DDS, MSD)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:TADDEI
Last Name:SA
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 GLENNOVER WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2152
Mailing Address - Country:US
Mailing Address - Phone:404-931-0910
Mailing Address - Fax:770-966-8774
Practice Address - Street 1:1880 W OAK PKWY
Practice Address - Street 2:SUITE 215
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2272
Practice Address - Country:US
Practice Address - Phone:770-966-9396
Practice Address - Fax:770-966-8774
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice