Provider Demographics
NPI:1003952128
Name:NEXDENTAL ASSOCIATES WOODSTOCK LLC
Entity Type:Organization
Organization Name:NEXDENTAL ASSOCIATES WOODSTOCK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:100 MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PELUSO
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-926-4447
Mailing Address - Street 1:8950 MAIN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4916
Mailing Address - Country:US
Mailing Address - Phone:770-926-4447
Mailing Address - Fax:770-924-6813
Practice Address - Street 1:8950 MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4916
Practice Address - Country:US
Practice Address - Phone:770-926-4447
Practice Address - Fax:770-924-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty