Provider Demographics
NPI:1952969396
Name:NS3 SERVICES, LLC
Entity Type:Organization
Organization Name:NS3 SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NIKKY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:470-747-7888
Mailing Address - Street 1:1039 GRANT ST SE STE B11
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-2050
Mailing Address - Country:US
Mailing Address - Phone:470-747-7888
Mailing Address - Fax:470-747-7999
Practice Address - Street 1:1039 GRANT ST SE STE B11
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-2050
Practice Address - Country:US
Practice Address - Phone:470-747-7888
Practice Address - Fax:470-747-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003161290AMedicaid