Provider Demographics
NPI:1811966625
Name:ABERDEEN DENTAL, LLC
Entity type:Organization
Organization Name:ABERDEEN DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-487-8298
Mailing Address - Street 1:300 NORTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3524
Mailing Address - Country:US
Mailing Address - Phone:770-487-8298
Mailing Address - Fax:770-487-5372
Practice Address - Street 1:300 NORTHLAKE DR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3524
Practice Address - Country:US
Practice Address - Phone:770-487-8298
Practice Address - Fax:770-487-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00045812AMedicaid
113706OtherUNITED CONCORDIA