Provider Demographics
NPI:1114405511
Name:SPOTLIGHT DENTAL ALPHARETTA
Entity Type:Organization
Organization Name:SPOTLIGHT DENTAL ALPHARETTA
Other - Org Name:SPOTLIGHT DENTAL ALPHARETTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PELUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-405-7756
Mailing Address - Street 1:3180 N POINT PKWY STE 522
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4569
Mailing Address - Country:US
Mailing Address - Phone:470-719-5181
Mailing Address - Fax:
Practice Address - Street 1:3180 N POINT PKWY STE 522
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4569
Practice Address - Country:US
Practice Address - Phone:470-719-5181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011882261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental