Provider Demographics
NPI:1659071140
Name:DENTISTRY OF NORCROSS LLC
Entity Type:Organization
Organization Name:DENTISTRY OF NORCROSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-249-1716
Mailing Address - Street 1:1401 PEACHTREE ST NE STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3005
Mailing Address - Country:US
Mailing Address - Phone:404-249-1716
Mailing Address - Fax:404-249-8057
Practice Address - Street 1:6063 PEACHTREE PKWY STE 201B
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3340
Practice Address - Country:US
Practice Address - Phone:770-448-4118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty