Provider Demographics
NPI:1164675203
Name:PK DENTAL
Entity Type:Organization
Organization Name:PK DENTAL
Other - Org Name:DENTAL WORLD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-984-9000
Mailing Address - Street 1:1410 TERRELL MILL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067
Mailing Address - Country:US
Mailing Address - Phone:770-984-9000
Mailing Address - Fax:770-984-9256
Practice Address - Street 1:1410 TERRELL MILL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:770-984-9000
Practice Address - Fax:770-984-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X, 1223S0112X
GADN013274261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA644170460DOtherDR WILLIAM KAPGAN
GA68579198COtherDR INESSA PLAVNIK