Healthcare Provider Details

I. General information

NPI: 1346344504
Provider Name (Legal Business Name): JEFFREY G PRILUCK DMD PC AND ALBERT P NORDONE DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5548 CHAMBLEE DUNWOODY ROAD
DUNWOODY GA
30338
US

IV. Provider business mailing address

5548 CHAMBLEE DUNWOODY ROAD
DUNWOODY GA
30338
US

V. Phone/Fax

Practice location:
  • Phone: 770-393-9450
  • Fax: 770-392-0647
Mailing address:
  • Phone: 770-393-9450
  • Fax: 770-392-0647

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: DR. JEFFREY G PRILUCK
Title or Position: OWNER PRESIDENT
Credential: DMD
Phone: 770-393-9450