Provider Demographics
NPI:1245041979
Name:CHASTAIN DENTAL GROUP LLC
Entity type:Organization
Organization Name:CHASTAIN DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-458-9908
Mailing Address - Street 1:3921 OBRYANT CIR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3906
Mailing Address - Country:US
Mailing Address - Phone:404-512-1889
Mailing Address - Fax:
Practice Address - Street 1:4920 ROSWELL RD STE 265
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2686
Practice Address - Country:US
Practice Address - Phone:404-458-9908
Practice Address - Fax:404-458-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental