Provider Demographics
NPI:1912005752
Name:DENTFIRST, P.C.
Entity Type:Organization
Organization Name:DENTFIRST, P.C.
Other - Org Name:DENTFIRST - PERIMETER
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTRACTS, CREDENTIALING MGR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-446-8000
Mailing Address - Street 1:1650 OAKBROOK DR.
Mailing Address - Street 2:STE 440
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093
Mailing Address - Country:US
Mailing Address - Phone:770-446-8000
Mailing Address - Fax:770-446-1354
Practice Address - Street 1:80 PERIMETER CENTER PLACE N.E.
Practice Address - Street 2:BLDG 2700
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346
Practice Address - Country:US
Practice Address - Phone:770-671-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7981122300000X
1223G0001X, 1223P0300X, 1223P0700X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty