Provider Demographics
NPI:1811222623
Name:SOFT TOUCH ENDODONTICS, PC
Entity Type:Organization
Organization Name:SOFT TOUCH ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/POSITION
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-831-7644
Mailing Address - Street 1:1120 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2013
Mailing Address - Country:US
Mailing Address - Phone:770-831-7644
Mailing Address - Fax:770-831-7641
Practice Address - Street 1:1120 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2013
Practice Address - Country:US
Practice Address - Phone:770-831-7644
Practice Address - Fax:770-831-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0117501223E0200X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty