Provider Demographics
NPI:1376179788
Name:ARBOR PLACE DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:ARBOR PLACE DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-210-0063
Mailing Address - Street 1:4904 TIMBER RIDGE DR STE 304
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1831
Mailing Address - Country:US
Mailing Address - Phone:678-838-9600
Mailing Address - Fax:
Practice Address - Street 1:4904 TIMBER RIDGE DR STE 304
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1831
Practice Address - Country:US
Practice Address - Phone:678-838-9600
Practice Address - Fax:678-838-4149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty