Provider Demographics
NPI:1124366794
Name:PREMPEH, CRYSTAL HAYES (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:HAYES
Last Name:PREMPEH
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GILMER WAY
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5255 STILESBORO RD NW
Practice Address - Street 2:SUITE 110
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7737
Practice Address - Country:US
Practice Address - Phone:770-499-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX284081223G0001X, 1223P0221X
NC99091223P0221X
GADN0152911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice