Provider Demographics
NPI:1407363963
Name:PD ORTHO LLC
Entity Type:Organization
Organization Name:PD ORTHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SATTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-651-1000
Mailing Address - Street 1:570 W CROSSVILLE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7517
Mailing Address - Country:US
Mailing Address - Phone:770-651-1000
Mailing Address - Fax:
Practice Address - Street 1:10930 CRABAPPLE RD STE 106
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5825
Practice Address - Country:US
Practice Address - Phone:770-651-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC DENTISTRY AND ORTHODONTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty