Provider Demographics
NPI:1770622201
Name:FOREST PARKWAY DENTAL GROUP
Entity type:Organization
Organization Name:FOREST PARKWAY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-363-1700
Mailing Address - Street 1:4930 GOVERNORS DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-6101
Mailing Address - Country:US
Mailing Address - Phone:404-363-1700
Mailing Address - Fax:850-837-2042
Practice Address - Street 1:4930 GOVERNORS DR
Practice Address - Street 2:SUITE 405
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6101
Practice Address - Country:US
Practice Address - Phone:404-363-1700
Practice Address - Fax:850-837-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty