Provider Demographics
NPI:1790086668
Name:DENTISTRY FOR CHILDREN OF GEORGIA LLC
Entity Type:Organization
Organization Name:DENTISTRY FOR CHILDREN OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-389-1950
Mailing Address - Street 1:1350 SPRING ST NW STE 600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2870
Mailing Address - Country:US
Mailing Address - Phone:404-389-1950
Mailing Address - Fax:678-444-4152
Practice Address - Street 1:1350 SPRING ST NW STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2870
Practice Address - Country:US
Practice Address - Phone:404-389-1950
Practice Address - Fax:678-444-4152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty