Provider Demographics
NPI:1265454102
Name:CHOICE DENTAL P.C
Entity Type:Organization
Organization Name:CHOICE DENTAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAJUMOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEDOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-966-7515
Mailing Address - Street 1:4484 JIMMY LEE SMITH PKWY
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2737
Mailing Address - Country:US
Mailing Address - Phone:770-222-7818
Mailing Address - Fax:770-222-7828
Practice Address - Street 1:4484 JIMMY LEE SMITH PKWY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2737
Practice Address - Country:US
Practice Address - Phone:770-222-7818
Practice Address - Fax:770-222-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012443261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental