MEDICARE: MIDTOWN DENTAL CENTER

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902073513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDTOWN DENTAL CENTER

Provider Business Mailing Address
First Line	:	650 PONCE DE LEON AVE NE
Second Line	:	SUITE 600 B
City	:	ATLANTA
State	:	GA
Zip	:	30308-1804
Country	:	US
Telephone Number	:	404-874-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 PONCE DE LEON AVE NE
Second Line	:	SUITE 600 B
City	:	ATLANTA
State	:	GA
Zip	:	30308-1804
Country	:	US
Telephone Number	:	404-874-0800
Fax Number	:

Authorized Official
Title or Position	:	DR/OWNER
Name	:	STANLEY G CARTER
Credential	:	D.D.S
Telephone Number	:	404-874-0800

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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Directions to “MIDTOWN DENTAL CENTER ” Practice Location

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