Provider Demographics
NPI:1306388475
Name:THE TEETH DOCTOR, LLC
Entity Type:Organization
Organization Name:THE TEETH DOCTOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GALANG
Authorized Official - Middle Name:THI
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-482-5170
Mailing Address - Street 1:6025 CUMMING HWY
Mailing Address - Street 2:#610
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5726
Mailing Address - Country:US
Mailing Address - Phone:678-482-5170
Mailing Address - Fax:678-804-6844
Practice Address - Street 1:6025 CUMMING HWY
Practice Address - Street 2:#610
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-5726
Practice Address - Country:US
Practice Address - Phone:678-482-5170
Practice Address - Fax:678-804-6844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty