Provider Demographics
NPI:1588236731
Name:ALPHARETTA DENTAL ASSOCIATES II PC
Entity Type:Organization
Organization Name:ALPHARETTA DENTAL ASSOCIATES II PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRALONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-662-5716
Mailing Address - Street 1:11790 NORTHFALL LN STE 401
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11790 NORTHFALL LN STE 401
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7965
Practice Address - Country:US
Practice Address - Phone:770-777-0511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental