Provider Demographics
NPI:1578988697
Name:HEARTLAND DENTAL CARE OF GEORGIA, P.C.
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF GEORGIA, P.C.
Other - Org Name:MILTON FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CRED. SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5170
Mailing Address - Street 1:12988 GEORGIA HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004
Mailing Address - Country:US
Mailing Address - Phone:678-691-2900
Mailing Address - Fax:678-609-6383
Practice Address - Street 1:12988 GEORGIA HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004
Practice Address - Country:US
Practice Address - Phone:678-691-2900
Practice Address - Fax:678-609-6383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF GEORGIA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty