Provider Demographics
NPI:1447632849
Name:PERIMETER DENTAL, LLC
Entity type:Organization
Organization Name:PERIMETER DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-522-0099
Mailing Address - Street 1:1140 HAMMOND DR
Mailing Address - Street 2:BUILDING K, SUITE 225
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5338
Mailing Address - Country:US
Mailing Address - Phone:770-522-0099
Mailing Address - Fax:770-522-0094
Practice Address - Street 1:1140 HAMMOND DR
Practice Address - Street 2:BUILDING K, SUITE 225
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5338
Practice Address - Country:US
Practice Address - Phone:770-522-0099
Practice Address - Fax:770-522-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty