Provider Demographics
NPI:1821394511
Name:KENNESTONE PERIODONTICS AT WINDY HILL, PC
Entity Type:Organization
Organization Name:KENNESTONE PERIODONTICS AT WINDY HILL, PC
Other - Org Name:LEE H SILVERSTEIN, DDS MS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:SILVERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:770-952-5432
Mailing Address - Street 1:2070 S PARK PL SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2045
Mailing Address - Country:US
Mailing Address - Phone:770-952-5432
Mailing Address - Fax:770-952-3011
Practice Address - Street 1:2070 S PARK PL SE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2045
Practice Address - Country:US
Practice Address - Phone:770-952-5432
Practice Address - Fax:770-952-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107421223P0300X
GA113841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1811082183OtherPROVIDER NPI NUMBER - SILVERSTEIN
GA1982798716OtherPERSONAL NPI NUMBER - SHATZ