Provider Demographics
NPI:1619017001
Name:NORTHPOINT DENTAL GROUP PC
Entity Type:Organization
Organization Name:NORTHPOINT DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:MAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-990-5980
Mailing Address - Street 1:3710 OLD MILTON PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:678-762-0535
Mailing Address - Fax:
Practice Address - Street 1:3710 OLD MILTON PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:678-762-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA9997122300000X
GAGA8077122300000X
GADN12408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID