Provider Demographics
NPI:1871351403
Name:TIMBER RIDGE DENTAL CENTER
Entity type:Organization
Organization Name:TIMBER RIDGE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-502-0722
Mailing Address - Street 1:5750 STEVEHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-5998
Mailing Address - Country:US
Mailing Address - Phone:706-502-0722
Mailing Address - Fax:866-923-3790
Practice Address - Street 1:137 PROMINENCE CT STE 140
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-8938
Practice Address - Country:US
Practice Address - Phone:706-265-6877
Practice Address - Fax:866-923-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental