Healthcare Provider Details

I. General information

NPI: 1528649639
Provider Name (Legal Business Name): BCFD SPECIALTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 PHARR RD NE STE A
ATLANTA GA
30305-2304
US

IV. Provider business mailing address

316 PHARR RD NE
ATLANTA GA
30305-2304
US

V. Phone/Fax

Practice location:
  • Phone: 404-400-0400
  • Fax:
Mailing address:
  • Phone: 404-400-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: SARA GARCIA
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 404-400-0400