Provider Demographics
NPI:1770023830
Name:COWETA DENTAL SLEEP THERAPY LLC
Entity Type:Organization
Organization Name:COWETA DENTAL SLEEP THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEMMIE
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-486-9400
Mailing Address - Street 1:260 S PEACHTREE PKWY
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1700
Mailing Address - Country:US
Mailing Address - Phone:770-486-9400
Mailing Address - Fax:770-252-6818
Practice Address - Street 1:260 S PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1700
Practice Address - Country:US
Practice Address - Phone:770-486-9400
Practice Address - Fax:770-252-6818
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COWETA DENTAL SLEEP THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-08
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0113131223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty