Provider Demographics
NPI:1043009939
Name:ATLANTA WELLNESS DENTISTRY
Entity type:Organization
Organization Name:ATLANTA WELLNESS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TEODORA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-932-9177
Mailing Address - Street 1:4690 WOODSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2089
Mailing Address - Country:US
Mailing Address - Phone:770-628-5647
Mailing Address - Fax:
Practice Address - Street 1:4690 WOODSTOCK RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2089
Practice Address - Country:US
Practice Address - Phone:770-628-5647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental