Provider Demographics
NPI:1437412889
Name:HAMILTON MILL ORAL AND FACIAL SURGERY, LLC
Entity Type:Organization
Organization Name:HAMILTON MILL ORAL AND FACIAL SURGERY, LLC
Other - Org Name:YADIRA CARDONA-ROHENA, DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AND DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDONA-ROHENA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-835-1135
Mailing Address - Street 1:4285 JIM MOORE RD
Mailing Address - Street 2:BLDG 100, SUITE 104
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1609
Mailing Address - Country:US
Mailing Address - Phone:678-835-1135
Mailing Address - Fax:678-835-1136
Practice Address - Street 1:4285 JIM MOORE RD
Practice Address - Street 2:BLDG 100, SUITE 104
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1609
Practice Address - Country:US
Practice Address - Phone:678-835-1135
Practice Address - Fax:678-835-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0134771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty