Provider Demographics
NPI:1114138039
Name:DULUTH FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DULUTH FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-814-7600
Mailing Address - Street 1:3312 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8100
Mailing Address - Country:US
Mailing Address - Phone:770-814-7600
Mailing Address - Fax:770-814-0824
Practice Address - Street 1:3312 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8100
Practice Address - Country:US
Practice Address - Phone:770-814-7600
Practice Address - Fax:770-814-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty