Provider Demographics
NPI:1073851572
Name:MINNITI DENTISTRY, PC
Entity Type:Organization
Organization Name:MINNITI DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:MINNITI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-990-8590
Mailing Address - Street 1:270 SAINT CLAIRE DR
Mailing Address - Street 2:SUITES 104-105
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5728
Mailing Address - Country:US
Mailing Address - Phone:678-990-8590
Mailing Address - Fax:678-990-8594
Practice Address - Street 1:270 SAINT CLAIRE DR
Practice Address - Street 2:SUITES 104-105
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-5728
Practice Address - Country:US
Practice Address - Phone:678-990-8590
Practice Address - Fax:678-990-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA58879DMMedicaid