Provider Demographics
NPI:1528398823
Name:ATLANTA WEST ORTHODONTIC CARE, PC
Entity Type:Organization
Organization Name:ATLANTA WEST ORTHODONTIC CARE, PC
Other - Org Name:EISENSTEIN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:EDUARD
Authorized Official - Last Name:EISENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-324-7877
Mailing Address - Street 1:215 ARBOR CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:404-324-7877
Mailing Address - Fax:
Practice Address - Street 1:1771 LEE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3071
Practice Address - Country:US
Practice Address - Phone:770-739-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012526261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental