Provider Demographics
NPI:1801389812
Name:CREATIVE DENTISTRY OF ATLANTA
Entity Type:Organization
Organization Name:CREATIVE DENTISTRY OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-883-3287
Mailing Address - Street 1:5505 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-883-3287
Mailing Address - Fax:404-883-3289
Practice Address - Street 1:5505 PEACHTREE DUNWOODY ROAD
Practice Address - Street 2:SUITE 460
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-883-3287
Practice Address - Fax:404-883-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty