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General NPI Number Information
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NPI Number | 1073516662
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Entity Type | Organization
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Legal Business Name | BUCKHEAD DENTAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3340 PEACHTREE RD NE STE 1685
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City | ATLANTA
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State | GA
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Zip | 30326-1012
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Country | US
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Telephone | 404-266-1300
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Fax | 404-365-8526
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Provider Business Mailing Address
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Address Line | 3340 PEACHTREE RD NE STE 1685
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City | ATLANTA
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State | GA
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Zip | 30326-1012
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Country | US
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Telephone | 404-266-1300
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Fax | 404-365-8526
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Authorized Official
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Title or Position | HIPAA COMPLIANCE OFFICER
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Name | KRISTIN BENNINGER
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Credential |
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Telephone | 404-266-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | GA8628 GA10187GA9232
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License Number State | GA
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