Provider Demographics
NPI:1629128988
Name:SUGARLOAF CROSSING DENTAL CENTER LLC
Entity Type:Organization
Organization Name:SUGARLOAF CROSSING DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-879-1177
Mailing Address - Street 1:4850 SUGARLOAF PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2859
Mailing Address - Country:US
Mailing Address - Phone:770-995-6109
Mailing Address - Fax:
Practice Address - Street 1:4850 SUGARLOAF PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2859
Practice Address - Country:US
Practice Address - Phone:770-995-6109
Practice Address - Fax:770-995-6128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service