Provider Demographics
NPI:1942374624
Name:CANDLER DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:CANDLER DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:G
Authorized Official - Last Name:PYE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-284-3015
Mailing Address - Street 1:2427 CANDLER RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032
Mailing Address - Country:US
Mailing Address - Phone:404-284-3015
Mailing Address - Fax:404-284-3309
Practice Address - Street 1:2427 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032
Practice Address - Country:US
Practice Address - Phone:404-284-3015
Practice Address - Fax:404-284-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00172233CMedicaid