Provider Demographics
NPI:1508312109
Name:CARTER ROCKBRIDGE GENERAL DENTISTRY, PC
Entity Type:Organization
Organization Name:CARTER ROCKBRIDGE GENERAL DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STINGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-662-5955
Mailing Address - Street 1:5050 JIMMY CARTER BLVD
Mailing Address - Street 2:STE. 320
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2711
Mailing Address - Country:US
Mailing Address - Phone:770-662-5955
Mailing Address - Fax:770-662-5628
Practice Address - Street 1:5050 JIMMY CARTER BLVD
Practice Address - Street 2:STE. 320
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2711
Practice Address - Country:US
Practice Address - Phone:770-662-5955
Practice Address - Fax:770-662-5628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011230261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental