Healthcare Provider Details

I. General information

NPI: 1538728787
Provider Name (Legal Business Name): K2 DENTAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 LOGANVILLE HWY STE 180
BETHLEHEM GA
30620-2162
US

IV. Provider business mailing address

916 LOGANVILLE HWY STE 180
BETHLEHEM GA
30620-2162
US

V. Phone/Fax

Practice location:
  • Phone: 770-868-0088
  • Fax: 770-868-0119
Mailing address:
  • Phone: 770-868-0088
  • Fax: 770-868-0119

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: MRS. ERICA LYNN DEYTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 770-868-0088