Provider Demographics
NPI:1235627696
Name:INMAN PARK DENTISTRY
Entity Type:Organization
Organization Name:INMAN PARK DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-589-7799
Mailing Address - Street 1:245 N HIGHLAND AVE NE STE 260
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1912
Mailing Address - Country:US
Mailing Address - Phone:404-589-7799
Mailing Address - Fax:404-214-9414
Practice Address - Street 1:245 N HIGHLAND AVE NE STE 260
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1912
Practice Address - Country:US
Practice Address - Phone:404-589-7799
Practice Address - Fax:404-214-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental