Provider Demographics
NPI:1326215237
Name:C S DENTAL
Entity Type:Organization
Organization Name:C S DENTAL
Other - Org Name:DOWNTOWN DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-577-0868
Mailing Address - Street 1:75 MARIETTA ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2883
Mailing Address - Country:US
Mailing Address - Phone:404-577-0868
Mailing Address - Fax:
Practice Address - Street 1:75 MARIETTA ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2883
Practice Address - Country:US
Practice Address - Phone:404-577-0868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0129931223G0001X
GAGA111691223G0001X
GA0114301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1174741953Medicaid
GA1720169451Medicaid
GA1003030941Medicaid