Provider Demographics
NPI:1659581163
Name:JOHNS CREEK DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:JOHNS CREEK DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-495-9575
Mailing Address - Street 1:3630 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6049
Mailing Address - Country:US
Mailing Address - Phone:770-495-9575
Mailing Address - Fax:770-495-8081
Practice Address - Street 1:3630 PEACHTREE PKWY
Practice Address - Street 2:SUITE 311
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6049
Practice Address - Country:US
Practice Address - Phone:770-495-9575
Practice Address - Fax:770-495-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty