Provider Demographics
NPI:1245671353
Name:CRABAPPLE FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:CRABAPPLE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOREAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BINGHAM CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-475-3700
Mailing Address - Street 1:12685 CRABAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6339
Mailing Address - Country:US
Mailing Address - Phone:770-475-3700
Mailing Address - Fax:770-664-2284
Practice Address - Street 1:12685 CRABAPPLE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6339
Practice Address - Country:US
Practice Address - Phone:770-475-3700
Practice Address - Fax:770-664-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013090261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental