Provider Demographics
NPI:1578809919
Name:GEORGIA DENTAL CARE INC
Entity Type:Organization
Organization Name:GEORGIA DENTAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMZEHPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-817-1007
Mailing Address - Street 1:5025 WINTERS CHAPEL RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1700
Mailing Address - Country:US
Mailing Address - Phone:770-817-1007
Mailing Address - Fax:770-817-1006
Practice Address - Street 1:5025 WINTERS CHAPEL RD
Practice Address - Street 2:SUITE F
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-1700
Practice Address - Country:US
Practice Address - Phone:770-817-1007
Practice Address - Fax:770-817-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental