Provider Demographics
NPI:1093990327
Name:BUCKHEAD PERIODONTICS, P.C.
Entity Type:Organization
Organization Name:BUCKHEAD PERIODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:DAY
Authorized Official - Last Name:BRASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-261-9593
Mailing Address - Street 1:2970 PEACHTREE RD NW
Mailing Address - Street 2:SUITE #622
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2192
Mailing Address - Country:US
Mailing Address - Phone:404-261-9593
Mailing Address - Fax:404-261-9409
Practice Address - Street 1:2970 PEACHTREE RD NW
Practice Address - Street 2:SUITE #622
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2192
Practice Address - Country:US
Practice Address - Phone:404-261-9593
Practice Address - Fax:404-261-9409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009901261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental