Healthcare Provider Details

I. General information

NPI: 1073851572
Provider Name (Legal Business Name): MINNITI DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 SAINT CLAIRE DR SUITES 104-105
ALPHARETTA GA
30004-5728
US

IV. Provider business mailing address

270 SAINT CLAIRE DR SUITES 104-105
ALPHARETTA GA
30004-5728
US

V. Phone/Fax

Practice location:
  • Phone: 678-990-8590
  • Fax: 678-990-8594
Mailing address:
  • Phone: 678-990-8590
  • Fax: 678-990-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LORENZO MINNITI
Title or Position: DENTIST
Credential: D.D.S.
Phone: 678-990-8590