Provider Demographics
NPI:1619482635
Name:AFFORDABLE DENTAL CARE , LLC
Entity Type:Organization
Organization Name:AFFORDABLE DENTAL CARE , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUDIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-279-2020
Mailing Address - Street 1:3993 LAWRENCEVILLE HWY NW STE 100A
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2831
Mailing Address - Country:US
Mailing Address - Phone:770-279-2020
Mailing Address - Fax:770-279-1222
Practice Address - Street 1:3993 LAWRENCEVILLE HWY NW STE 100A
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2831
Practice Address - Country:US
Practice Address - Phone:770-279-2020
Practice Address - Fax:770-279-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1700080793OtherNPI
GA1255510624OtherNPI