Provider Demographics
NPI:1245533868
Name:HEARTLAND DENTAL CARE OF GEORGIA
Entity type:Organization
Organization Name:HEARTLAND DENTAL CARE OF GEORGIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:1595 PEACHTREE PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9583
Mailing Address - Country:US
Mailing Address - Phone:770-888-8282
Mailing Address - Fax:
Practice Address - Street 1:1595 PEACHTREE PKWY STE 207
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9583
Practice Address - Country:US
Practice Address - Phone:770-888-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty