Provider Demographics
NPI:1871794628
Name:SANDY SPRINGS DENTAL CLINIC
Entity type:Organization
Organization Name:SANDY SPRINGS DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:CECELIA
Authorized Official - Last Name:MARZOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-261-3436
Mailing Address - Street 1:5302 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-9139
Mailing Address - Country:US
Mailing Address - Phone:864-261-3436
Mailing Address - Fax:
Practice Address - Street 1:5302 HWY 76
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29677-9139
Practice Address - Country:US
Practice Address - Phone:864-261-3436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty