Provider Demographics
NPI:1649740796
Name:SANDY SPRINGS ORAL SURGERY, LLC
Entity Type:Organization
Organization Name:SANDY SPRINGS ORAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SAFWAT
Authorized Official - Last Name:ATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-987-2637
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD STE G56
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1700
Mailing Address - Country:US
Mailing Address - Phone:404-252-5626
Mailing Address - Fax:404-252-9651
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD STE G56
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1700
Practice Address - Country:US
Practice Address - Phone:404-252-5626
Practice Address - Fax:404-252-9651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-02
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty