Provider Demographics
NPI:1184760753
Name:DULUTH DENTAL ASSOCIATES
Entity type:Organization
Organization Name:DULUTH DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RITTGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-417-7709
Mailing Address - Street 1:3415 DULUTH HWY 120
Mailing Address - Street 2:#B
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:678-412-7709
Mailing Address - Fax:628-417-7071
Practice Address - Street 1:3415 B E LAWRENCEVILLE ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:678-412-7709
Practice Address - Fax:678-417-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12813122300000X
GA13018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty