Provider Demographics
NPI:1255687794
Name:HEARTLAND DENTAL CARE OF GEORGIA
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF GEORGIA
Other - Org Name:GOLDSTEIN GARBER AND SALAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5146
Mailing Address - Street 1:600 GALLERIA PKWY SE STE 800
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5992
Mailing Address - Country:US
Mailing Address - Phone:404-261-4941
Mailing Address - Fax:
Practice Address - Street 1:600 GALLERIA PKWY SE STE 800
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5992
Practice Address - Country:US
Practice Address - Phone:404-261-4941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty