Provider Demographics
NPI:1619374659
Name:ATLANTA DENTAL CENTER, LLC
Entity Type:Organization
Organization Name:ATLANTA DENTAL CENTER, LLC
Other - Org Name:ATLANTA DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BENK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-872-7755
Mailing Address - Street 1:620 PEACHTREE ST NE STE 204
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2355
Mailing Address - Country:US
Mailing Address - Phone:404-872-7755
Mailing Address - Fax:877-583-7599
Practice Address - Street 1:620 PEACHTREE ST NE STE 204
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2355
Practice Address - Country:US
Practice Address - Phone:404-872-7755
Practice Address - Fax:877-583-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014823122300000X
GA0121147122300000X
GADN014327122300000X
GA105151223G0001X
GA0141521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1699868281OtherDR. ROBERT SCHMIDT
GA1992890107OtherDR. ROBERT VAZQUEZ
GA1750438685OtherDR. MARIA PAPPAS
GA1568878684OtherDR. BRITTANY CORBETT
GA1043528193OtherDR. JESSICA LEE