Provider Demographics
NPI:1235662529
Name:COSMETIC DENTISTRY CENTER OF ALPHARETTA
Entity Type:Organization
Organization Name:COSMETIC DENTISTRY CENTER OF ALPHARETTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-366-2322
Mailing Address - Street 1:3070 WINDWARD PLZ
Mailing Address - Street 2:SUITE R
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8771
Mailing Address - Country:US
Mailing Address - Phone:678-366-2322
Mailing Address - Fax:
Practice Address - Street 1:3070 WINDWARD PLZ
Practice Address - Street 2:SUITE R
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-8771
Practice Address - Country:US
Practice Address - Phone:678-366-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty