Provider Demographics
NPI:1013188929
Name:ATHENS DENTISTRY FOR CHILDREN
Entity type:Organization
Organization Name:ATHENS DENTISTRY FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-355-3109
Mailing Address - Street 1:115 TAPP WOOD RD
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-2807
Mailing Address - Country:US
Mailing Address - Phone:706-355-3109
Mailing Address - Fax:
Practice Address - Street 1:2470 DANIELS BRIDGE RD
Practice Address - Street 2:SUITE 231
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6187
Practice Address - Country:US
Practice Address - Phone:706-355-3109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty