Provider Demographics
NPI:1558829523
Name:DENTCARE DENTAL LAB USA INC
Entity Type:Organization
Organization Name:DENTCARE DENTAL LAB USA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-525-9083
Mailing Address - Street 1:2640 BRIARFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2345
Mailing Address - Country:US
Mailing Address - Phone:678-525-9083
Mailing Address - Fax:678-609-1632
Practice Address - Street 1:3915 ROSEBUD RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4608
Practice Address - Country:US
Practice Address - Phone:678-525-9083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory