Provider Demographics
NPI:1235117375
Name:SHURETT DENTAL GROUP PC
Entity Type:Organization
Organization Name:SHURETT DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TITSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-760-7900
Mailing Address - Street 1:1816 LAKEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013
Mailing Address - Country:US
Mailing Address - Phone:770-860-8760
Mailing Address - Fax:770-760-1375
Practice Address - Street 1:1816 LAKEFIELD CT
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013
Practice Address - Country:US
Practice Address - Phone:770-860-8760
Practice Address - Fax:770-760-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental