Provider Demographics
NPI:1922533868
Name:NEWTOWN FAMILY DENTAL PC
Entity Type:Organization
Organization Name:NEWTOWN FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-571-6984
Mailing Address - Street 1:3280 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8544
Mailing Address - Country:US
Mailing Address - Phone:404-437-7331
Mailing Address - Fax:404-437-7599
Practice Address - Street 1:3280 OLD ALABAMA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-8544
Practice Address - Country:US
Practice Address - Phone:404-437-7331
Practice Address - Fax:404-437-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3481511OtherUNITED CONCORDIA
GA904873006EMedicaid