Provider Demographics
NPI:1205360377
Name:ALPHARETTA PEDIATRIC AND FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:ALPHARETTA PEDIATRIC AND FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:VAKHARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-716-7907
Mailing Address - Street 1:8560 HOLCOMB BRIDGE RD STE 119
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5322
Mailing Address - Country:US
Mailing Address - Phone:770-642-9824
Mailing Address - Fax:
Practice Address - Street 1:8560 HOLCOMB BRIDGE RD STE 119
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-5322
Practice Address - Country:US
Practice Address - Phone:770-642-9824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN010318122300000X
GADN0132181223G0001X
GADN0151121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty