Provider Demographics
NPI:1437283025
Name:CHILDREN'S DENTISTRY AT HAMILTON MILL
Entity Type:Organization
Organization Name:CHILDREN'S DENTISTRY AT HAMILTON MILL
Other - Org Name:CHILDRENS DENTISTRY AT GAINESVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUGHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-714-7011
Mailing Address - Street 1:2119 HAMILTON CREEK PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3293
Mailing Address - Country:US
Mailing Address - Phone:678-714-7011
Mailing Address - Fax:678-714-8388
Practice Address - Street 1:2119 HAMILTON CREEK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-3293
Practice Address - Country:US
Practice Address - Phone:678-714-7011
Practice Address - Fax:678-714-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA120821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty