Provider Demographics
NPI:1639542459
Name:PEACHTREE DUNWOODY ORAL AND FACIAL SURGERY, PC
Entity Type:Organization
Organization Name:PEACHTREE DUNWOODY ORAL AND FACIAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY KUHMICHEL
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:KUHMICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-892-2999
Mailing Address - Street 1:999 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 715
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3915
Mailing Address - Country:US
Mailing Address - Phone:404-892-2999
Mailing Address - Fax:404-815-7730
Practice Address - Street 1:999 PEACHTREE ST NE
Practice Address - Street 2:SUITE 715
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3915
Practice Address - Country:US
Practice Address - Phone:404-892-2999
Practice Address - Fax:404-815-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0136871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty