Provider Demographics
NPI:1831542083
Name:RAGAN L FALER DMD PC
Entity type:Organization
Organization Name:RAGAN L FALER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAGAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FALER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-289-0382
Mailing Address - Street 1:239 VILLAGE CENTER PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9024
Mailing Address - Country:US
Mailing Address - Phone:678-289-0382
Mailing Address - Fax:678-289-0383
Practice Address - Street 1:239 VILLAGE CENTER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9024
Practice Address - Country:US
Practice Address - Phone:678-289-0382
Practice Address - Fax:678-289-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty