Provider Demographics
NPI:1679001630
Name:AMASON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:AMASON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:L
Authorized Official - Last Name:AMASON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-424-1705
Mailing Address - Street 1:2430 POWELL PL NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3567
Mailing Address - Country:US
Mailing Address - Phone:770-424-1705
Mailing Address - Fax:770-429-1610
Practice Address - Street 1:2430 POWELL PL NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3567
Practice Address - Country:US
Practice Address - Phone:770-424-1705
Practice Address - Fax:770-429-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty