Provider Demographics
NPI:1134491657
Name:HEARTLAND DENTAL CARE OF GEORGIA, P.C.
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF GEORGIA, P.C.
Other - Org Name:MYNORTHATLANTADENTIST.COM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:5252 ROSWELL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1969
Mailing Address - Country:US
Mailing Address - Phone:404-252-5252
Mailing Address - Fax:404-252-1676
Practice Address - Street 1:5252 ROSWELL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1969
Practice Address - Country:US
Practice Address - Phone:404-252-5252
Practice Address - Fax:404-252-1676
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF GEORGIA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty