Provider Demographics
NPI:1952609869
Name:SPOTLIGHT FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:SPOTLIGHT FAMILY DENTAL LLC
Other - Org Name:SPOTLIGHT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PELUSO
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-405-7756
Mailing Address - Street 1:980 SANDERS ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5977
Mailing Address - Country:US
Mailing Address - Phone:770-205-3111
Mailing Address - Fax:770-205-3311
Practice Address - Street 1:980 SANDERS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5977
Practice Address - Country:US
Practice Address - Phone:770-205-3111
Practice Address - Fax:770-205-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0118821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty