Provider Demographics
NPI:1225798929
Name:PROGRESSIVE DG, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE DG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUNDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:EADY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-479-7602
Mailing Address - Street 1:2485 PARK CENTRAL BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2485 PARK CENTRAL BLVD STE 3
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3903
Practice Address - Country:US
Practice Address - Phone:770-593-4976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty