Provider Demographics
NPI:1609092279
Name:AMANDA W. CONTI, D.M.D, LLC
Entity Type:Organization
Organization Name:AMANDA W. CONTI, D.M.D, LLC
Other - Org Name:AMANDA W. CONTI, D.M.D., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-727-2211
Mailing Address - Street 1:300 WALNUT GROVE RD SE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-6431
Mailing Address - Country:US
Mailing Address - Phone:770-727-2211
Mailing Address - Fax:770-727-2213
Practice Address - Street 1:300 WALNUT GROVE RD SE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-6431
Practice Address - Country:US
Practice Address - Phone:770-727-2211
Practice Address - Fax:770-727-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA115371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty