Provider Demographics
NPI:1790905784
Name:HENSON AND BIDGOLY LLLP
Entity Type:Organization
Organization Name:HENSON AND BIDGOLY LLLP
Other - Org Name:METRO DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BIDGOLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-957-3506
Mailing Address - Street 1:175 DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-2025
Mailing Address - Country:US
Mailing Address - Phone:770-957-9113
Mailing Address - Fax:770-957-7341
Practice Address - Street 1:175 DECATUR RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-2025
Practice Address - Country:US
Practice Address - Phone:770-957-9113
Practice Address - Fax:770-957-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA115351223G0001X
GA74341223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty