Provider Demographics
NPI:1922764653
Name:FAMILY AND CHILDREN'S DENTISTRY & ORTHODONTICS
Entity Type:Organization
Organization Name:FAMILY AND CHILDREN'S DENTISTRY & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-349-7777
Mailing Address - Street 1:2440 FAIRBURN RD SW STE 301
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5255
Mailing Address - Country:US
Mailing Address - Phone:404-349-7777
Mailing Address - Fax:
Practice Address - Street 1:2440 FAIRBURN RD SW STE 301
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5255
Practice Address - Country:US
Practice Address - Phone:404-349-7777
Practice Address - Fax:404-349-8459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty