Healthcare Provider Details

I. General information

NPI: 1942655816
Provider Name (Legal Business Name): DENTAL RESCUE THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 VERNON GLEN CT
ATLANTA GA
30338-5422
US

IV. Provider business mailing address

39 VERNON GLEN CT
ATLANTA GA
30338-5422
US

V. Phone/Fax

Practice location:
  • Phone: 404-247-5970
  • Fax:
Mailing address:
  • Phone: 404-247-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. ARUN NAYYAR
Title or Position: PRESIDENT
Credential: DMD, MS
Phone: 404-247-5970