Healthcare Provider Details

I. General information

NPI: 1386193662
Provider Name (Legal Business Name): CUMMING DENTAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12385 CRABAPPLE RD SUITE 101
ALPHARETTA GA
30004-6357
US

IV. Provider business mailing address

12385 CRABAPPLE RD SUITE 101
ALPHARETTA GA
30004-6357
US

V. Phone/Fax

Practice location:
  • Phone: 770-781-8650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN011242
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN015174
License Number StateGA

VIII. Authorized Official

Name: KEVIN SHORT
Title or Position: OWNER
Credential: DDS
Phone: 770-781-8650