Provider Demographics
NPI:1225576986
Name:COMPLETE DENTAL ARTS, P.C.
Entity Type:Organization
Organization Name:COMPLETE DENTAL ARTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-254-8787
Mailing Address - Street 1:2819 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1331
Mailing Address - Country:US
Mailing Address - Phone:770-254-8787
Mailing Address - Fax:877-556-4889
Practice Address - Street 1:2819 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1331
Practice Address - Country:US
Practice Address - Phone:770-254-8787
Practice Address - Fax:877-556-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013135305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization