Provider Demographics
NPI:1326176991
Name:PIEDMONT PERIODONTICS
Entity Type:Organization
Organization Name:PIEDMONT PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BARTRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-815-4800
Mailing Address - Street 1:1512 PIEDMONT AVE NE
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5044
Mailing Address - Country:US
Mailing Address - Phone:404-815-4800
Mailing Address - Fax:404-815-0002
Practice Address - Street 1:222 12TH STREET
Practice Address - Street 2:SUITE 1B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-5044
Practice Address - Country:US
Practice Address - Phone:404-815-4800
Practice Address - Fax:404-815-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0123891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty