Provider Demographics
NPI:1790256758
Name:CCSD-HAMILTON MILL,LLC
Entity Type:Organization
Organization Name:CCSD-HAMILTON MILL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOORDIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NURANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-932-8577
Mailing Address - Street 1:2725 HAMILTON MILL RD STE 700
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6010
Mailing Address - Country:US
Mailing Address - Phone:770-932-8577
Mailing Address - Fax:770-932-3277
Practice Address - Street 1:2725 HAMILTON MILL RD STE 700
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-6010
Practice Address - Country:US
Practice Address - Phone:770-932-8577
Practice Address - Fax:770-932-3277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CENTER FOR COSMETIC AND SEDATION DENTISTRY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental