Provider Demographics
NPI:1558773218
Name:CALHOUN DENTISTRY, LLC
Entity Type:Organization
Organization Name:CALHOUN DENTISTRY, LLC
Other - Org Name:CALHOUN FAMILY DENTSITRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-629-8822
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-0906
Mailing Address - Country:US
Mailing Address - Phone:706-629-8822
Mailing Address - Fax:706-629-8893
Practice Address - Street 1:908 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1969
Practice Address - Country:US
Practice Address - Phone:706-629-8822
Practice Address - Fax:706-629-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty