Provider Demographics
NPI:1629946645
Name:WHITE DENTAL CLINIC
Entity type:Organization
Organization Name:WHITE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KYUNGTAEK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-717-9341
Mailing Address - Street 1:2730 PEACHTREE INDUSTRIAL BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8628
Mailing Address - Country:US
Mailing Address - Phone:470-222-4995
Mailing Address - Fax:
Practice Address - Street 1:2730 PEACHTREE INDUSTRIAL BLVD STE 202
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8628
Practice Address - Country:US
Practice Address - Phone:404-666-5746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-29
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental