Provider Demographics
NPI:1407635873
Name:PERIMETER DENTAL MIDTOWN
Entity Type:Organization
Organization Name:PERIMETER DENTAL MIDTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-525-7712
Mailing Address - Street 1:77 12TH ST NE STE 1
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3972
Mailing Address - Country:US
Mailing Address - Phone:770-525-7712
Mailing Address - Fax:
Practice Address - Street 1:77 12TH ST NE STE 1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3972
Practice Address - Country:US
Practice Address - Phone:770-525-7712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental