Healthcare Provider Details

I. General information

NPI: 1497676704
Provider Name (Legal Business Name): WAVE DENTAL SPECIALISTS ATLANTA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 PEACHTREE RD NE STE 203
ATLANTA GA
30309-1121
US

IV. Provider business mailing address

2285 PEACHTREE RD NE STE 203
ATLANTA GA
30309-1121
US

V. Phone/Fax

Practice location:
  • Phone: 470-828-5497
  • 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 State

VIII. Authorized Official

Name: JENNIFER EMM
Title or Position: VP OPERATIONS
Credential:
Phone: 313-268-0322