Provider Demographics
NPI:1235595687
Name:GEORGIA DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:GEORGIA DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER AND REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SANKET
Authorized Official - Middle Name:
Authorized Official - Last Name:KARMARKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-356-7689
Mailing Address - Street 1:3100 FIVE FORKS TRICKUM ROAD SUITE 201
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 FIVE FORKS TRICKUM ROAD SUITE 201
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047
Practice Address - Country:US
Practice Address - Phone:770-978-3292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental