Provider Demographics
NPI:1952655581
Name:MH ORTHODONTICS
Entity Type:Organization
Organization Name:MH ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-420-8462
Mailing Address - Street 1:125 TOWNPARK DR NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5803
Mailing Address - Country:US
Mailing Address - Phone:770-420-8462
Mailing Address - Fax:
Practice Address - Street 1:1030 W GORDON AVE STE A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-4515
Practice Address - Country:US
Practice Address - Phone:229-432-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty