Provider Demographics
NPI:1821496134
Name:NORTH ATLANTA AESTHETIC DENTISTRY, PC.
Entity Type:Organization
Organization Name:NORTH ATLANTA AESTHETIC DENTISTRY, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:GURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-664-1244
Mailing Address - Street 1:4165 OLD MILTON PARKWAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-664-1244
Mailing Address - Fax:770-695-0143
Practice Address - Street 1:4165 OLD MILTON PARKWAY
Practice Address - Street 2:SUITE 140
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-664-1244
Practice Address - Fax:770-695-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011186261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental