Provider Demographics
NPI:1437320298
Name:ATLANTA COMPLETE DENTAL CARE, P. C.
Entity Type:Organization
Organization Name:ATLANTA COMPLETE DENTAL CARE, P. C.
Other - Org Name:CHOICE DENTAL CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-723-3788
Mailing Address - Street 1:65 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4629
Mailing Address - Country:US
Mailing Address - Phone:678-407-3919
Mailing Address - Fax:678-407-3918
Practice Address - Street 1:65 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-4629
Practice Address - Country:US
Practice Address - Phone:678-407-3919
Practice Address - Fax:678-407-3918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty