Provider Demographics
NPI:1669510194
Name:LAWRENCEVILLE HWY DENTAL GROUP
Entity Type:Organization
Organization Name:LAWRENCEVILLE HWY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZANZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-491-1132
Mailing Address - Street 1:2785 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2515
Mailing Address - Country:US
Mailing Address - Phone:770-491-1132
Mailing Address - Fax:770-491-8628
Practice Address - Street 1:2785 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2515
Practice Address - Country:US
Practice Address - Phone:770-491-1132
Practice Address - Fax:770-491-8628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty