Provider Demographics
NPI:1215205661
Name:DENTISTRY FOR CHILDREN OF CARTERSVILLE LLC
Entity Type:Organization
Organization Name:DENTISTRY FOR CHILDREN OF CARTERSVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-389-1950
Mailing Address - Street 1:1350 SPRING ST NW
Mailing Address - Street 2:SIXTH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2864
Mailing Address - Country:US
Mailing Address - Phone:404-389-1950
Mailing Address - Fax:
Practice Address - Street 1:11 BOWEN CT
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2493
Practice Address - Country:US
Practice Address - Phone:404-389-1950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty