Healthcare Provider Details

I. General information

NPI: 1467364406
Provider Name (Legal Business Name): PRIUMDENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 PEACHTREE INDUSTRIAL BLVD STE 113
DULUTH GA
30097-8170
US

IV. Provider business mailing address

2805 PEACHTREE INDUSTRIAL BLVD STE 113
DULUTH GA
30097-8170
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-2252
  • Fax:
Mailing address:
  • Phone: 770-476-2252
  • 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: MIA AHN
Title or Position: PRESIDENT
Credential: DDS
Phone: 770-476-2252