Provider Demographics
NPI:1780029942
Name:DOWNTOWN ATLANTA DENTISTRY
Entity Type:Organization
Organization Name:DOWNTOWN ATLANTA DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-537-5211
Mailing Address - Street 1:229 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-1601
Mailing Address - Country:US
Mailing Address - Phone:404-522-7913
Mailing Address - Fax:
Practice Address - Street 1:229 PEACHTREE ST NE
Practice Address - Street 2:SUITE 206
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1601
Practice Address - Country:US
Practice Address - Phone:404-522-7913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty