Provider Demographics
NPI:1598189284
Name:ALPHARETTA PEDIATRIC DENTISTRY AND ORTHODONTICS
Entity Type:Organization
Organization Name:ALPHARETTA PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Name:DENTISTRY AT ALPHARETTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VISHANT
Authorized Official - Middle Name:
Authorized Official - Last Name:NATH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-735-4560
Mailing Address - Street 1:1030 CAMBRIDGE SQ STE B
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1868
Mailing Address - Country:US
Mailing Address - Phone:678-735-4560
Mailing Address - Fax:678-735-4600
Practice Address - Street 1:1030 CAMBRIDGE SQ STE B
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1868
Practice Address - Country:US
Practice Address - Phone:678-735-4560
Practice Address - Fax:678-735-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty