Provider Demographics
NPI:1659672269
Name:FAMILY ORTHODONTICS OF DVILLE, LLC
Entity Type:Organization
Organization Name:FAMILY ORTHODONTICS OF DVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-445-9191
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-0195
Mailing Address - Country:US
Mailing Address - Phone:678-445-9191
Mailing Address - Fax:678-445-9173
Practice Address - Street 1:100 DAWSON COMMONS CIR
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6264
Practice Address - Country:US
Practice Address - Phone:678-445-9191
Practice Address - Fax:678-445-9173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty