Provider Demographics
NPI:1134342090
Name:CARTERSVILLE FAMILY DENTISTRY, P.C.
Entity type:Organization
Organization Name:CARTERSVILLE FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-387-9249
Mailing Address - Street 1:624 N TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2858
Mailing Address - Country:US
Mailing Address - Phone:770-387-9249
Mailing Address - Fax:770-387-2285
Practice Address - Street 1:624 N TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2858
Practice Address - Country:US
Practice Address - Phone:770-387-9249
Practice Address - Fax:770-387-2285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARTERSVILLE FAMILY DENTISTRY,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112891223G0001X
GA112661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty