Provider Demographics
NPI:1033380050
Name:NUKOA FAMILY DENTAL
Entity Type:Organization
Organization Name:NUKOA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-813-0777
Mailing Address - Street 1:3705 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4313
Mailing Address - Country:US
Mailing Address - Phone:770-813-0777
Mailing Address - Fax:
Practice Address - Street 1:3705 OLD NORCROSS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4313
Practice Address - Country:US
Practice Address - Phone:770-813-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012668261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA561235509AMedicaid
GA626075029 AMedicaid