Provider Demographics
NPI:1558115485
Name:NORTH GEORGIA ORAL AND FACIAL SURGERY LLC
Entity Type:Organization
Organization Name:NORTH GEORGIA ORAL AND FACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-ORAL AND MAXILLOFACIAL SURGEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWDUCHERUVU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-914-1691
Mailing Address - Street 1:5198 DINANT DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6532
Mailing Address - Country:US
Mailing Address - Phone:248-914-1691
Mailing Address - Fax:
Practice Address - Street 1:3400 MCCLURE BRIDGE RD
Practice Address - Street 2:BLDG G, SUITES B AND C
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-476-8576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty