Provider Demographics
NPI:1326312109
Name:SPECIALITY DENTAL SERVICES OF GEORGIA
Entity Type:Organization
Organization Name:SPECIALITY DENTAL SERVICES OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:LIPSOKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:866-275-2767
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-0000
Mailing Address - Country:US
Mailing Address - Phone:866-275-2767
Mailing Address - Fax:678-324-4413
Practice Address - Street 1:2758 LOST LAKES DR.
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-0000
Practice Address - Country:US
Practice Address - Phone:866-275-2767
Practice Address - Fax:678-324-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty