Provider Demographics
NPI:1437694791
Name:AESTHETIC RESTORATIVE DENTISTRY, P. C.
Entity Type:Organization
Organization Name:AESTHETIC RESTORATIVE DENTISTRY, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:W
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:DOMINY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-631-0044
Mailing Address - Street 1:5000 SHAKERAG HL
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3367
Mailing Address - Country:US
Mailing Address - Phone:770-631-0044
Mailing Address - Fax:770-631-9434
Practice Address - Street 1:5000 SHAKERAG HL
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3367
Practice Address - Country:US
Practice Address - Phone:770-631-0044
Practice Address - Fax:770-631-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0108881223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty