Provider Demographics
NPI:1912200528
Name:WINDY HILL DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:WINDY HILL DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-312-5167
Mailing Address - Street 1:2070 S PARK PL SE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2045
Mailing Address - Country:US
Mailing Address - Phone:770-955-1188
Mailing Address - Fax:
Practice Address - Street 1:2070 S PARK PL SE
Practice Address - Street 2:SUITE 330
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2045
Practice Address - Country:US
Practice Address - Phone:770-955-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty