Provider Demographics
NPI:1710991179
Name:NADLER, DAVID M (MD, DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:NADLER
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6304 OLD HIGHWAY 5
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2443
Mailing Address - Country:US
Mailing Address - Phone:770-591-9555
Mailing Address - Fax:
Practice Address - Street 1:6304 OLD HIGHWAY 5
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2443
Practice Address - Country:US
Practice Address - Phone:770-591-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA544251223S0112X
KY73121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA223905239AMedicaid
GA223905239AMedicaid
GA85BBBDGMedicare ID - Type Unspecified