Provider Demographics
NPI:1891336830
Name:ATLANTA DENTAL FITNESS
Entity Type:Organization
Organization Name:ATLANTA DENTAL FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:V
Authorized Official - Last Name:VANSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-578-5388
Mailing Address - Street 1:2296 HENDERSON MILL RD NE STE 109
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2739
Mailing Address - Country:US
Mailing Address - Phone:678-578-5388
Mailing Address - Fax:404-393-5128
Practice Address - Street 1:2296 HENDERSON MILL RD NE STE 109
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2739
Practice Address - Country:US
Practice Address - Phone:678-578-5388
Practice Address - Fax:404-393-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental