Provider Demographics
NPI:1275298648
Name:HAMILTON MILL DENTAL CENTER, LLC
Entity Type:Organization
Organization Name:HAMILTON MILL DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-945-4445
Mailing Address - Street 1:2055 HAMILTON CREEK PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7205
Mailing Address - Country:US
Mailing Address - Phone:678-622-1822
Mailing Address - Fax:
Practice Address - Street 1:2055 HAMILTON CREEK PKWY STE 140
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7205
Practice Address - Country:US
Practice Address - Phone:678-622-1822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental