Provider Demographics
NPI:1831316280
Name:EAST MARIETTA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:EAST MARIETTA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HANSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-977-1632
Mailing Address - Street 1:3823 ROSWELL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6278
Mailing Address - Country:US
Mailing Address - Phone:770-977-1632
Mailing Address - Fax:770-578-8140
Practice Address - Street 1:3823 ROSWELL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6278
Practice Address - Country:US
Practice Address - Phone:770-977-1632
Practice Address - Fax:770-578-8140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7874261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental