Provider Demographics
NPI:1609334549
Name:SUGAR HILL FAMILY AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:SUGAR HILL FAMILY AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:LANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-765-8650
Mailing Address - Street 1:5885 CUMMING HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5687
Mailing Address - Country:US
Mailing Address - Phone:678-765-8650
Mailing Address - Fax:
Practice Address - Street 1:5885 CUMMING HWY STE 104
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-5687
Practice Address - Country:US
Practice Address - Phone:678-765-8650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
321456OtherCODE