SOUTHEAST ORAL DIAGNOSTICS LLC NPI 1063378966

NPI Information

  • NPI: 1063378966
  • Provider Name: SOUTHEAST ORAL DIAGNOSTICS LLC
  • Classification: Dentist - 1223P0106X
  • Specialization: Oral and Maxillofacial Pathology
  • Entity Type: Organization
  • Address: 282 RUCKER RD STE 110
    ALPHARETTA, GA
    ZIP 30004
  • Phone: (770) 992-4844

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NPI Details

SOUTHEAST ORAL DIAGNOSTICS LLC is an oral and maxillofacial pathology dentist in Alpharetta, GA. The provider is the specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations. SOUTHEAST ORAL DIAGNOSTICS LLC NPI is 1063378966. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

282 RUCKER RD STE 110
ALPHARETTA, GA
ZIP 30004-826
Phone: (770) 992-4844

The provider's authorized official is Stephanie Wetzel .
The authorized official title is Owner/ Dentist and has the following contact phone number (770) 992-4844.

The enumeration date for this NPI number is 1/5/2026 and was last updated on 1/5/2026.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0106XDentistOral and Maxillofacial PathologyYes

What is NPI?

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This page was last updated on: 11/21/2025

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