Provider Demographics
NPI:1972012961
Name:NEWNAN PERIODONTICS LLC
Entity Type:Organization
Organization Name:NEWNAN PERIODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FALER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-252-0029
Mailing Address - Street 1:1635 HIGHWAY 34 E STE A
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2173
Mailing Address - Country:US
Mailing Address - Phone:770-252-0029
Mailing Address - Fax:770-252-0091
Practice Address - Street 1:1635 HIGHWAY 34 E STE A
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2173
Practice Address - Country:US
Practice Address - Phone:770-252-0029
Practice Address - Fax:770-252-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty