Provider Demographics
NPI:1700429115
Name:DTJG DENTAL GROUP LLC
Entity Type:Organization
Organization Name:DTJG DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HILDRETH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-664-3563
Mailing Address - Street 1:351 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8727
Mailing Address - Country:US
Mailing Address - Phone:404-664-3563
Mailing Address - Fax:
Practice Address - Street 1:2430 POWELL PL NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3567
Practice Address - Country:US
Practice Address - Phone:770-424-1705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental