Provider Demographics
NPI:1598334906
Name:KDNGA LLC
Entity Type:Organization
Organization Name:KDNGA LLC
Other - Org Name:KID'S DENTISTRY OF NORTH GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-450-7011
Mailing Address - Street 1:1207 SHERWOOD PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3444
Mailing Address - Country:US
Mailing Address - Phone:678-450-7011
Mailing Address - Fax:678-971-4201
Practice Address - Street 1:1207 SHERWOOD PARK DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3444
Practice Address - Country:US
Practice Address - Phone:678-450-7011
Practice Address - Fax:678-971-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003175666BMedicaid
GA1790049047OtherNPI
GA1790985620OtherNPI
GA801406612BMedicaid