Healthcare Provider Details

I. General information

NPI: 1689538613
Provider Name (Legal Business Name): AMBER ARCH DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 CUMBERLAND PKWY SE
ATLANTA GA
30339-5008
US

IV. Provider business mailing address

2355 CUMBERLAND PKWY SE
ATLANTA GA
30339-5008
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONOVAN PHILLIPS
Title or Position: OWNER
Credential:
Phone: 470-827-4021