Provider Demographics
NPI:1265180236
Name:DENTISTRY OF SANDY SPRINGS LLC
Entity type:Organization
Organization Name:DENTISTRY OF SANDY SPRINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-677-1311
Mailing Address - Street 1:5600 ROSWELL RD STE K120
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1262
Mailing Address - Country:US
Mailing Address - Phone:404-809-3400
Mailing Address - Fax:
Practice Address - Street 1:5600 ROSWELL RD STE K120
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1262
Practice Address - Country:US
Practice Address - Phone:404-809-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental