Provider Demographics
NPI:1114086477
Name:CHOICE ONE DENTAL CARE
Entity Type:Organization
Organization Name:CHOICE ONE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-614-4022
Mailing Address - Street 1:1930 BUFORD MILL DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-8602
Mailing Address - Country:US
Mailing Address - Phone:770-614-4022
Mailing Address - Fax:
Practice Address - Street 1:1930 BUFORD MILL DR
Practice Address - Street 2:SUITE F
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-8602
Practice Address - Country:US
Practice Address - Phone:770-614-4022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty