Provider Demographics
NPI:1922475987
Name:OJIBWAY DENTAL GROUP
Entity Type:Organization
Organization Name:OJIBWAY DENTAL GROUP
Other - Org Name:DUNWOODY FAMILY & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-399-9199
Mailing Address - Street 1:1816 INDEPENDENCE SQ
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5137
Mailing Address - Country:US
Mailing Address - Phone:770-399-9199
Mailing Address - Fax:770-399-6746
Practice Address - Street 1:1816 INDEPENDENCE SQ
Practice Address - Street 2:SUITE B
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5137
Practice Address - Country:US
Practice Address - Phone:770-399-9199
Practice Address - Fax:770-399-6746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty