Provider Demographics
NPI:1295218881
Name:DENTAL NATION PC
Entity Type:Organization
Organization Name:DENTAL NATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-644-5963
Mailing Address - Street 1:589 AUBURN AVE NE UNIT A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1990
Mailing Address - Country:US
Mailing Address - Phone:404-644-5963
Mailing Address - Fax:
Practice Address - Street 1:4343 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5542
Practice Address - Country:US
Practice Address - Phone:404-644-5963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1508206046OtherDENTAL