Provider Demographics
NPI:1922139567
Name:AV DENTAL CARE, PC
Entity Type:Organization
Organization Name:AV DENTAL CARE, PC
Other - Org Name:PATIENT 1ST DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLABHANENI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,
Authorized Official - Phone:770-455-0628
Mailing Address - Street 1:3273 SHALLOWFORD RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3632
Mailing Address - Country:US
Mailing Address - Phone:770-455-0628
Mailing Address - Fax:770-451-7521
Practice Address - Street 1:3273 SHALLOWFORD RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3632
Practice Address - Country:US
Practice Address - Phone:770-455-0628
Practice Address - Fax:770-451-7521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0122731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty