Provider Demographics
NPI:1790225001
Name:ADVANCED DENTAL AESTHETICS
Entity Type:Organization
Organization Name:ADVANCED DENTAL AESTHETICS
Other - Org Name:SAVANNAH DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:ROSARIO
Authorized Official - Last Name:PATTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-354-9204
Mailing Address - Street 1:5509 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4902
Mailing Address - Country:US
Mailing Address - Phone:912-354-9204
Mailing Address - Fax:
Practice Address - Street 1:5509 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4902
Practice Address - Country:US
Practice Address - Phone:912-354-9204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014401261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental