Provider Demographics
NPI:1023357464
Name:BOOKER ORAL SURGERY & IMPLANT CENTER PC
Entity Type:Organization
Organization Name:BOOKER ORAL SURGERY & IMPLANT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEWTON-BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-932-8869
Mailing Address - Street 1:335 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 2210
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3756
Mailing Address - Country:US
Mailing Address - Phone:770-932-8869
Mailing Address - Fax:770-932-8870
Practice Address - Street 1:335 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 2210
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3756
Practice Address - Country:US
Practice Address - Phone:770-932-8869
Practice Address - Fax:770-932-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1538204524OtherINDIVIDUAL NPI NUMBER