MEDICARE: NEW FOUNDATION DENTAL IMPLANT CENTERS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1366026338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW FOUNDATION DENTAL IMPLANT CENTERS, P.C.

Provider Business Mailing Address
First Line	:	296 S MAIN ST STE 300
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-1973
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 EAGLE DR STE 200-A
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-8274
Country	:	US
Telephone Number	:	770-238-1437
Fax Number	:

Authorized Official
Title or Position	:	VP OF INTEGRATION AND ADMINISTRATIO
Name	:	BEN CUTLER
Credential	:
Telephone Number	:	607-743-9474

Provider Enumeration Date	:	05/06/2021
Last Update Date	:	05/12/2022

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