Provider Demographics
NPI:1770851396
Name:COUNTY DENTAL PROVIDERS, INC
Entity Type:Organization
Organization Name:COUNTY DENTAL PROVIDERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SZEWCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-443-8411
Mailing Address - Street 1:254 ROSWELL ST SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2064
Mailing Address - Country:US
Mailing Address - Phone:770-443-8411
Mailing Address - Fax:770-443-8985
Practice Address - Street 1:254 ROSWELL ST SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2064
Practice Address - Country:US
Practice Address - Phone:770-443-8411
Practice Address - Fax:770-443-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty