Provider Demographics
NPI:1356665301
Name:CHILDREN'S DENTISTRY OF SANDY SPRINGS
Entity Type:Organization
Organization Name:CHILDREN'S DENTISTRY OF SANDY SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASARCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-445-5444
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-0195
Mailing Address - Country:US
Mailing Address - Phone:678-445-5444
Mailing Address - Fax:678-445-5222
Practice Address - Street 1:5590 ROSWELL RD
Practice Address - Street 2:STE A270
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-1909
Practice Address - Country:US
Practice Address - Phone:678-445-5444
Practice Address - Fax:678-445-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO118961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty