Provider Demographics
NPI:1033665732
Name:DENTECARE DENTAL LLC
Entity Type:Organization
Organization Name:DENTECARE DENTAL LLC
Other - Org Name:DENTAL SMILES AT JOHNS CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DEVANG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-751-1500
Mailing Address - Street 1:5455 MCGINNIS VILLAGE PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-751-1500
Mailing Address - Fax:770-751-1508
Practice Address - Street 1:5455 MCGINNIS VILLAGE PL
Practice Address - Street 2:SUITE 103
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-751-1500
Practice Address - Fax:770-751-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty