Provider Demographics
NPI:1295180750
Name:MEADOWBROOK FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MEADOWBROOK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-522-3635
Mailing Address - Street 1:2405 SATELLITE BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5818
Mailing Address - Country:US
Mailing Address - Phone:770-622-5909
Mailing Address - Fax:
Practice Address - Street 1:2405 SATELLITE BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5818
Practice Address - Country:US
Practice Address - Phone:770-622-5909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental