Provider Demographics
NPI:1932554870
Name:ALPHARETTA FAMILY DENTAL ASSOC., INC.
Entity Type:Organization
Organization Name:ALPHARETTA FAMILY DENTAL ASSOC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-475-4040
Mailing Address - Street 1:11685 ALPHARETTA HWY
Mailing Address - Street 2:SUITE NO: 220
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3806
Mailing Address - Country:US
Mailing Address - Phone:770-475-4040
Mailing Address - Fax:770-475-7050
Practice Address - Street 1:11685 ALPHARETTA HWY
Practice Address - Street 2:SUITE NO: 220
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3806
Practice Address - Country:US
Practice Address - Phone:770-475-4040
Practice Address - Fax:770-475-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty