Healthcare Provider Details

I. General information

NPI: 1780588939
Provider Name (Legal Business Name): CHIRA DENTAL OF NORCROSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 BEAVER RUIN RD STE 175
NORCROSS GA
30071-3850
US

IV. Provider business mailing address

1905 BEAVER RUIN RD STE 175
NORCROSS GA
30071-3850
US

V. Phone/Fax

Practice location:
  • Phone: 678-722-5212
  • Fax:
Mailing address:
  • Phone: 678-722-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MIKE CHIRA
Title or Position: MANAGER
Credential:
Phone: 224-628-6190