Provider Demographics
NPI:1871853366
Name:INTERNATIONAL HARVEST DENTISTRY
Entity Type:Organization
Organization Name:INTERNATIONAL HARVEST DENTISTRY
Other - Org Name:INTERNATIONAL HARVEST MINISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MARIUS
Authorized Official - Last Name:DINULESCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-262-4096
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD NE STE G73
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1787
Mailing Address - Country:US
Mailing Address - Phone:770-262-4096
Mailing Address - Fax:404-256-0901
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD NE STE G73
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1787
Practice Address - Country:US
Practice Address - Phone:770-262-4096
Practice Address - Fax:404-256-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11011261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental