Provider Demographics
NPI:1114071495
Name:CHOATE DENTAL ASSOC PC
Entity Type:Organization
Organization Name:CHOATE DENTAL ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTISTQ
Authorized Official - Prefix:
Authorized Official - First Name:TINSLEY
Authorized Official - Middle Name:CHOATE
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-382-0921
Mailing Address - Street 1:211 E MAIN ST PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120
Mailing Address - Country:US
Mailing Address - Phone:770-382-0921
Mailing Address - Fax:770-607-1821
Practice Address - Street 1:211 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120
Practice Address - Country:US
Practice Address - Phone:770-382-0921
Practice Address - Fax:770-607-1821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty