Provider Demographics
NPI:1003295650
Name:ALPHA& OMEGA HEALTH CENTER, INC
Entity Type:Organization
Organization Name:ALPHA& OMEGA HEALTH CENTER, INC
Other - Org Name:ALPHARETTA FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LEAFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-475-9630
Mailing Address - Street 1:30 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1508
Mailing Address - Country:US
Mailing Address - Phone:770-475-9630
Mailing Address - Fax:770-475-7038
Practice Address - Street 1:30 MILTON AVE
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1508
Practice Address - Country:US
Practice Address - Phone:770-475-9630
Practice Address - Fax:770-475-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty