Provider Demographics
NPI:1073408340
Name:DENTISTRY OF BROOKHAVEN CORPORATION
Entity type:Organization
Organization Name:DENTISTRY OF BROOKHAVEN CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COLLECTIONS
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-651-1000
Mailing Address - Street 1:10930 CRABAPPLE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5825
Mailing Address - Country:US
Mailing Address - Phone:770-651-1000
Mailing Address - Fax:678-212-1973
Practice Address - Street 1:2221 JOHNSON FERRY RD NE STE 2A
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2203
Practice Address - Country:US
Practice Address - Phone:770-651-1000
Practice Address - Fax:678-212-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty