Provider Demographics
NPI:1659996593
Name:CHILDREN'S DENTAL CENTER PC
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL CENTER PC
Other - Org Name:CHOICE ONE DENTAL CARE OF CARTERSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-387-4533
Mailing Address - Street 1:650 HENDERSON DR STE 205
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3756
Mailing Address - Country:US
Mailing Address - Phone:770-387-4533
Mailing Address - Fax:
Practice Address - Street 1:650 HENDERSON DR STE 205
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3756
Practice Address - Country:US
Practice Address - Phone:770-387-4533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty