Provider Demographics
NPI:1952935710
Name:WEST COBB PERIODONTICS AND IMPLANT DENTISTRY LLC
Entity Type:Organization
Organization Name:WEST COBB PERIODONTICS AND IMPLANT DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-384-3080
Mailing Address - Street 1:44 OLD HAMILTON RD NW STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5901
Mailing Address - Country:US
Mailing Address - Phone:770-802-2222
Mailing Address - Fax:
Practice Address - Street 1:44 OLD HAMILTON RD NW STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5901
Practice Address - Country:US
Practice Address - Phone:770-802-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental