Provider Demographics
NPI:1386193662
Name:CUMMING DENTAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:CUMMING DENTAL ASSOCIATES, PC
Other - Org Name:ALPHARETTA FAMILY & SPECIALTY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-781-8650
Mailing Address - Street 1:12385 CRABAPPLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12385 CRABAPPLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6357
Practice Address - Country:US
Practice Address - Phone:770-781-8650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011242122300000X
GADN015174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty