Provider Demographics
NPI:1558616045
Name:WINDY HILL DENTISTRY, LLC
Entity Type:Organization
Organization Name:WINDY HILL DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-405-8707
Mailing Address - Street 1:997 WINDY HILL RD SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:997 WINDY HILL RD SE
Practice Address - Street 2:SUITE C
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2045
Practice Address - Country:US
Practice Address - Phone:770-405-8707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty