Provider Demographics
NPI:1336310192
Name:PARNES FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:PARNES FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-213-9051
Mailing Address - Street 1:3999 AUSTELL RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1100
Mailing Address - Country:US
Mailing Address - Phone:404-213-9051
Mailing Address - Fax:678-990-4072
Practice Address - Street 1:3999 AUSTELL RD
Practice Address - Street 2:SUITE 304
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1100
Practice Address - Country:US
Practice Address - Phone:404-213-9051
Practice Address - Fax:678-990-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9179575Medicaid
GA165930Medicaid
GA107477Medicaid
GA100362Medicaid