Provider Demographics
NPI:1790916484
Name:DENTISTRY AT WINDERMERE, P.C.
Entity Type:Organization
Organization Name:DENTISTRY AT WINDERMERE, P.C.
Other - Org Name:DENTISTRY AT WINDERMERE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-205-1212
Mailing Address - Street 1:2950 BUFORD HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8215
Mailing Address - Country:US
Mailing Address - Phone:770-205-1212
Mailing Address - Fax:770-205-1211
Practice Address - Street 1:2950 BUFORD HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8215
Practice Address - Country:US
Practice Address - Phone:770-205-1212
Practice Address - Fax:770-205-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
GADN013420261QD0000X
GADN013473261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental