Provider Demographics
NPI:1255088274
Name:VILLAGE FAMILY DENTAL LLC
Entity type:Organization
Organization Name:VILLAGE FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-797-5228
Mailing Address - Street 1:449 PLEASANT HILL RD NW STE 101
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2770
Mailing Address - Country:US
Mailing Address - Phone:770-797-5228
Mailing Address - Fax:678-587-5910
Practice Address - Street 1:449 PLEASANT HILL RD NW STE 101
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2770
Practice Address - Country:US
Practice Address - Phone:770-797-5228
Practice Address - Fax:678-587-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty