Provider Demographics
NPI:1407195142
Name:STOCKBRIDGE DENTAL LLC
Entity Type:Organization
Organization Name:STOCKBRIDGE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RIMA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-389-1980
Mailing Address - Street 1:150 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9089
Mailing Address - Country:US
Mailing Address - Phone:770-389-1980
Mailing Address - Fax:770-389-5128
Practice Address - Street 1:150 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 201
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9089
Practice Address - Country:US
Practice Address - Phone:770-389-1980
Practice Address - Fax:770-389-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0108661223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty