Provider Demographics
NPI:1205246493
Name:LOYNES DENTAL CARE, LLC
Entity type:Organization
Organization Name:LOYNES DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MURGESH
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-574-2812
Mailing Address - Street 1:1196 PINE GROVE RD
Mailing Address - Street 2:P O BOX 275
Mailing Address - City:TALLAPOOSA
Mailing Address - State:GA
Mailing Address - Zip Code:30176-3137
Mailing Address - Country:US
Mailing Address - Phone:770-574-2812
Mailing Address - Fax:770-574-5020
Practice Address - Street 1:1196 PINE GROVE RD
Practice Address - Street 2:
Practice Address - City:TALLAPOOSA
Practice Address - State:GA
Practice Address - Zip Code:30176-3137
Practice Address - Country:US
Practice Address - Phone:770-574-2812
Practice Address - Fax:770-574-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003134346BMedicaid