Provider Demographics
NPI:1952407397
Name:IMAGIX 2 DENTAL
Entity Type:Organization
Organization Name:IMAGIX 2 DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WITKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-448-9333
Mailing Address - Street 1:5075 PEACHTREE PKWY
Mailing Address - Street 2:105B
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-6508
Mailing Address - Country:US
Mailing Address - Phone:770-448-9333
Mailing Address - Fax:
Practice Address - Street 1:5075 PEACHTREE PKWY
Practice Address - Street 2:105B
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-6508
Practice Address - Country:US
Practice Address - Phone:770-448-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty