Provider Demographics
NPI:1912059866
Name:AT DENTAL, P.C
Entity Type:Organization
Organization Name:AT DENTAL, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TU
Authorized Official - Middle Name:ANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-277-0774
Mailing Address - Street 1:1154 LAWRENCEVILLE HWY
Mailing Address - Street 2:STE. 102
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2434
Mailing Address - Country:US
Mailing Address - Phone:770-277-0774
Mailing Address - Fax:770-277-0520
Practice Address - Street 1:1154 LAWRENCEVILLE HWY
Practice Address - Street 2:STE. 102
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-2434
Practice Address - Country:US
Practice Address - Phone:770-277-0774
Practice Address - Fax:770-277-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty