Healthcare Provider Details

I. General information

NPI: 1023895653
Provider Name (Legal Business Name): DENTISTRYONE OF GEORGIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NORTHSIDE DR NW STE A7
ATLANTA GA
30318-2695
US

IV. Provider business mailing address

20 HIGHLAND AVE
METUCHEN NJ
08840-1949
US

V. Phone/Fax

Practice location:
  • Phone: 877-712-7875
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRANT HERMAN
Title or Position: CEO
Credential:
Phone: 877-712-7875