Provider Demographics
NPI:1346389863
Name:NORTH ROBERTS ROAD DENTAL GROUP
Entity Type:Organization
Organization Name:NORTH ROBERTS ROAD DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VENICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-423-9699
Mailing Address - Street 1:1301 SHILOH RD NW
Mailing Address - Street 2:BLD 600 SUITE 660
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7147
Mailing Address - Country:US
Mailing Address - Phone:770-423-9699
Mailing Address - Fax:850-837-7448
Practice Address - Street 1:1301 SHILOH RD NW
Practice Address - Street 2:BLD 600 SUITE 660
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7147
Practice Address - Country:US
Practice Address - Phone:770-423-9699
Practice Address - Fax:850-837-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty