Provider Demographics
NPI:1629406004
Name:VERDE POINTE DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:VERDE POINTE DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KIMMERLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-423-4900
Mailing Address - Street 1:3698 LARGENT WAY NW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5923
Mailing Address - Country:US
Mailing Address - Phone:770-423-4900
Mailing Address - Fax:770-590-8694
Practice Address - Street 1:3698 LARGENT WAY NW
Practice Address - Street 2:SUITE 202
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5923
Practice Address - Country:US
Practice Address - Phone:770-423-4900
Practice Address - Fax:770-590-8694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0096871223G0001X
GADN0138911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty