Provider Demographics
NPI:1669721452
Name:CENTRE' FOR COSMETIC DENTISTRY
Entity type:Organization
Organization Name:CENTRE' FOR COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:ACREE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-883-3443
Mailing Address - Street 1:PO BOX 72267
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2267
Mailing Address - Country:US
Mailing Address - Phone:229-883-3443
Mailing Address - Fax:229-883-6755
Practice Address - Street 1:2824 GILLIONVILLE RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-2904
Practice Address - Country:US
Practice Address - Phone:229-883-3443
Practice Address - Fax:229-883-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0112941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty