Provider Demographics
NPI:1184650350
Name:EAST COBB FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:EAST COBB FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAYDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-992-2340
Mailing Address - Street 1:2969 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5653
Mailing Address - Country:US
Mailing Address - Phone:770-992-2340
Mailing Address - Fax:770-587-0240
Practice Address - Street 1:2969 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5653
Practice Address - Country:US
Practice Address - Phone:770-992-2340
Practice Address - Fax:770-587-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty