Healthcare Provider Details

I. General information

NPI: 1699836569
Provider Name (Legal Business Name): COMPREHENSIVE DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MOUTAIN VIEW DRIVE SUITE A
CUMMING GA
30041
US

IV. Provider business mailing address

103 MOUTAIN VIEW DR SUITE A
CUMMING GA
30040
US

V. Phone/Fax

Practice location:
  • Phone: 770-887-0447
  • Fax: 770-887-9521
Mailing address:
  • Phone: 770-887-0447
  • Fax: 770-887-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number9671
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9671
License Number StateGA

VIII. Authorized Official

Name: DR. MARK S. ZEMAN
Title or Position: DOCTOR
Credential: D.M.D.
Phone: 770-887-0447