Provider Demographics
NPI:1952008179
Name:HAVEN DENTAL CARE GROUP LLC
Entity Type:Organization
Organization Name:HAVEN DENTAL CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-624-4912
Mailing Address - Street 1:3312 PEACHTREE INDUSTRIAL BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8100
Mailing Address - Country:US
Mailing Address - Phone:770-545-8647
Mailing Address - Fax:
Practice Address - Street 1:3312 PEACHTREE INDUSTRIAL BLVD STE 8
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8100
Practice Address - Country:US
Practice Address - Phone:770-545-8647
Practice Address - Fax:770-545-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental