Provider Demographics
NPI:1689225161
Name:OAKWOOD FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:OAKWOOD FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHUSHBU
Authorized Official - Middle Name:
Authorized Official - Last Name:MODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-622-6290
Mailing Address - Street 1:2302 PARKLAKE DR NE STE 513 #479
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2896
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3885 MUNDY MILL RD STE 116
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3432
Practice Address - Country:US
Practice Address - Phone:832-622-6290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty