Provider Demographics
NPI:1952171852
Name:DENTAL MAX LLC
Entity Type:Organization
Organization Name:DENTAL MAX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIEZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-888-8282
Mailing Address - Street 1:1595 PEACHTREE PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9583
Mailing Address - Country:US
Mailing Address - Phone:770-888-8282
Mailing Address - Fax:
Practice Address - Street 1:1595 PEACHTREE PKWY STE 207
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9583
Practice Address - Country:US
Practice Address - Phone:770-888-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental