Provider Demographics
NPI:1881150498
Name:DENTAL PROFESSIONALS OF GEORGIA, P.C.
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF GEORGIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8946
Mailing Address - Street 1:645 BEAVER RUIN RD NW STE A
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3471
Mailing Address - Country:US
Mailing Address - Phone:770-381-9320
Mailing Address - Fax:
Practice Address - Street 1:645 BEAVER RUIN RD NW STE A
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3471
Practice Address - Country:US
Practice Address - Phone:770-381-9320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty