Healthcare Provider Details

I. General information

NPI: 1750584009
Provider Name (Legal Business Name): EAST 53RD STREET DENTAL-3, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 FORT HARRISON RD
TERRA HAUTE IN
47804
US

IV. Provider business mailing address

210 INTERSTATE NORTH PKWY SE STE 300
ATLANTA GA
30339-2233
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-5665
  • Fax: 678-904-5665
Mailing address:
  • Phone: 770-916-5028
  • Fax: 678-247-7858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER IGOE
Title or Position: OWNER
Credential: DMD
Phone: 770-916-5036