Provider Demographics
NPI:1134308216
Name:DAVID H. DOGGETT BORDEAUX DDS LLC
Entity Type:Organization
Organization Name:DAVID H. DOGGETT BORDEAUX DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H DOGGETT
Authorized Official - Last Name:BORDEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-249-1716
Mailing Address - Street 1:855 JUNIPER STREET NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-249-1716
Mailing Address - Fax:404-249-8057
Practice Address - Street 1:855 JUNIPER STREET NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-249-1716
Practice Address - Fax:404-249-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty