Provider Demographics
NPI:1689169096
Name:DENTAL CARE CENTER OF DECATUR LLC
Entity Type:Organization
Organization Name:DENTAL CARE CENTER OF DECATUR LLC
Other - Org Name:LYNN LIVINGSTON SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-939-9779
Mailing Address - Street 1:2530 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:770-939-9779
Mailing Address - Fax:770-939-2393
Practice Address - Street 1:2530 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:770-939-9779
Practice Address - Fax:770-939-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty