Provider Demographics
NPI:1376910372
Name:COMPLETE DENTAL OF SUWANEE
Entity Type:Organization
Organization Name:COMPLETE DENTAL OF SUWANEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEELIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:312-399-1496
Mailing Address - Street 1:2133 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2648
Mailing Address - Country:US
Mailing Address - Phone:678-377-6453
Mailing Address - Fax:
Practice Address - Street 1:2133 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 13
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2648
Practice Address - Country:US
Practice Address - Phone:678-377-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO138001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty