Provider Demographics
NPI:1841884392
Name:DENTAL IMAGES 916, LLC
Entity type:Organization
Organization Name:DENTAL IMAGES 916, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SABI
Authorized Official - Middle Name:
Authorized Official - Last Name:VUKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-995-9255
Mailing Address - Street 1:916 LAWRENCEVILLE HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4706
Mailing Address - Country:US
Mailing Address - Phone:770-995-9255
Mailing Address - Fax:770-995-9686
Practice Address - Street 1:916 LAWRENCEVILLE HWY STE 201
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4706
Practice Address - Country:US
Practice Address - Phone:770-995-9255
Practice Address - Fax:770-995-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental