Provider Demographics
NPI:1043042591
Name:SUGARLOAF CHILDRENS DENTISTRY
Entity type:Organization
Organization Name:SUGARLOAF CHILDRENS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-813-9393
Mailing Address - Street 1:1299 OLD PEACHTREE RD NW STE 102103
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2028
Mailing Address - Country:US
Mailing Address - Phone:770-813-9393
Mailing Address - Fax:
Practice Address - Street 1:1299 OLD PEACHTREE RD NW STE 102103
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2028
Practice Address - Country:US
Practice Address - Phone:770-813-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental