MEDICARE: ATLANTA EMERGENCY DENTIST LLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1730024415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA EMERGENCY DENTIST LLC

Provider Business Mailing Address
First Line	:	1275 MCCONNELL DR STE G
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 MCCONNELL DR STE G
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3505
Country	:	US
Telephone Number	:	925-457-6881
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DANNY NGUYEN
Credential	:
Telephone Number	:	925-457-6881

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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