Healthcare Provider Details

I. General information

NPI: 1760996656
Provider Name (Legal Business Name): CUMMING DENTAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7185 COLFAX AVE.
CUMMING GA
30040
US

IV. Provider business mailing address

PO BOX 599
CUMMING GA
30028-0599
US

V. Phone/Fax

Practice location:
  • Phone: 770-781-8650
  • Fax:
Mailing address:
  • Phone: 770-781-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN014775
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN015174
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN015214
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN012306
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN015212
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN015146
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN011424
License Number StateGA
# 8
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN011242
License Number StateGA

VIII. Authorized Official

Name: LINDA MONELL
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 770-781-8650