Provider Demographics
NPI:1164744157
Name:STEELE FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:STEELE FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CECOLIA
Authorized Official - Middle Name:LAVONT
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-592-7000
Mailing Address - Street 1:116 MIRRAMOUNT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8213
Mailing Address - Country:US
Mailing Address - Phone:770-592-7000
Mailing Address - Fax:770-517-7403
Practice Address - Street 1:116 MIRRAMOUNT LAKE DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8213
Practice Address - Country:US
Practice Address - Phone:770-592-7000
Practice Address - Fax:770-517-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009205261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00210834CMedicaid