Provider Demographics
NPI:1376844852
Name:CRBAPPLE ORAL SURGERY LLC
Entity Type:Organization
Organization Name:CRBAPPLE ORAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JBARTCH
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-710-6000
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:678-710-6000
Mailing Address - Fax:678-710-6001
Practice Address - Street 1:100 DAWSON COMMONS CIR
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6264
Practice Address - Country:US
Practice Address - Phone:678-710-6000
Practice Address - Fax:678-710-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty