Provider Demographics
NPI:1710522065
Name:GEORGIA DENTAL ALLIANCE OF GREENSBORO
Entity Type:Organization
Organization Name:GEORGIA DENTAL ALLIANCE OF GREENSBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-986-7116
Mailing Address - Street 1:1000 COWLES CLINC WAY STE W-200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-4539
Mailing Address - Country:US
Mailing Address - Phone:706-454-0044
Mailing Address - Fax:
Practice Address - Street 1:1000 COWLES CLINC WAY STE W-200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-4539
Practice Address - Country:US
Practice Address - Phone:706-454-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty