Provider Demographics
NPI:1043766322
Name:MOUNTAIN VIEW DENTAL LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:RHINESMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-429-8989
Mailing Address - Street 1:2320 BAKER ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101
Mailing Address - Country:US
Mailing Address - Phone:770-429-8989
Mailing Address - Fax:770-429-1997
Practice Address - Street 1:2320 BAKER RD NW
Practice Address - Street 2:SUITE B
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6842
Practice Address - Country:US
Practice Address - Phone:770-429-8989
Practice Address - Fax:770-429-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9192122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7565950001Medicare NSC