Provider Demographics
NPI:1073084448
Name:D.A.M.C DENTAL & MEDICAL RESOURCES 1 LLC.,
Entity Type:Organization
Organization Name:D.A.M.C DENTAL & MEDICAL RESOURCES 1 LLC.,
Other - Org Name:SMILE WITH CONFIDENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD OF THE DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROYAL
Authorized Official - Middle Name:
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-446-7018
Mailing Address - Street 1:5284 JIMMY CARTER BLVD STE D&E
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1650
Mailing Address - Country:US
Mailing Address - Phone:678-263-3042
Mailing Address - Fax:678-672-3131
Practice Address - Street 1:5284 JIMMY CARTER BLVD STE D&E
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1650
Practice Address - Country:US
Practice Address - Phone:678-263-3042
Practice Address - Fax:678-672-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA053400193OtherDENTAL INSURANCE