Provider Demographics
NPI:1851773899
Name:ALPHARETTA CREEK RESTORATIVE DENTISTRY LLC
Entity Type:Organization
Organization Name:ALPHARETTA CREEK RESTORATIVE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHU KAI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-777-2803
Mailing Address - Street 1:11180 STATE BRIDGE RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7482
Mailing Address - Country:US
Mailing Address - Phone:770-777-2803
Mailing Address - Fax:770-619-7066
Practice Address - Street 1:11180 STATE BRIDGE RD
Practice Address - Street 2:SUITE 405
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-7482
Practice Address - Country:US
Practice Address - Phone:770-777-2803
Practice Address - Fax:770-619-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0144311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty