Provider Demographics
NPI:1568633311
Name:MEDICAL DENTAL MANAGEMENT SERVICES, INC.
Entity Type:Organization
Organization Name:MEDICAL DENTAL MANAGEMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-604-9944
Mailing Address - Street 1:1150 HAMMOND DR NE
Mailing Address - Street 2:C-3120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5334
Mailing Address - Country:US
Mailing Address - Phone:770-604-9944
Mailing Address - Fax:770-604-9945
Practice Address - Street 1:1150 HAMMOND DR NE
Practice Address - Street 2:C-3120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5334
Practice Address - Country:US
Practice Address - Phone:770-604-9944
Practice Address - Fax:770-604-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9184187OtherDORAL DENTAL