Provider Demographics
NPI:1821251299
Name:HABERSHAM DENTAL PARTNERS, LLC
Entity Type:Organization
Organization Name:HABERSHAM DENTAL PARTNERS, LLC
Other - Org Name:HABERSHAM DENTAL, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-234-2206
Mailing Address - Street 1:2515 HABERSHAM STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401
Mailing Address - Country:US
Mailing Address - Phone:912-234-2206
Mailing Address - Fax:
Practice Address - Street 1:2515 HABERSHAM STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401
Practice Address - Country:US
Practice Address - Phone:912-234-2206
Practice Address - Fax:912-238-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0094681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9181094OtherDORAL
GA000228621AMedicaid