Provider Demographics
NPI:1235754151
Name:ANESTHESIOLOGISTS FOR DENTAL SEDATION LLC
Entity Type:Organization
Organization Name:ANESTHESIOLOGISTS FOR DENTAL SEDATION LLC
Other - Org Name:ANESTHESIOLOGISTS FOR OUTPATIENT SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-FOUNDING PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:KANE
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-889-2326
Mailing Address - Street 1:3625 BRASELTON HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4695
Mailing Address - Country:US
Mailing Address - Phone:678-889-2326
Mailing Address - Fax:470-238-3658
Practice Address - Street 1:3625 BRASELTON HWY STE 201
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4695
Practice Address - Country:US
Practice Address - Phone:678-889-2326
Practice Address - Fax:470-238-3658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty