Provider Demographics
NPI:1316202872
Name:ZOOM DENTAL LLC
Entity Type:Organization
Organization Name:ZOOM DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-921-9000
Mailing Address - Street 1:4574 LAWRENCEVILLE HWY NW STE 120
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3605
Mailing Address - Country:US
Mailing Address - Phone:770-921-9000
Mailing Address - Fax:770-931-7704
Practice Address - Street 1:4574 LAWRENCEVILLE HWY NW STE 120
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3605
Practice Address - Country:US
Practice Address - Phone:770-921-9000
Practice Address - Fax:770-931-7704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN109841223G0001X
GADN0144071223G0001X
GADN0137001223P0221X
GADN0130141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty