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General NPI Number Information
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NPI Number | 1073810610
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN DENTAL CARE, P.C.
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 4060 PEACHTREE ROAD, N.E. SUITE H
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City | ATLANTA
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State | GA
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Zip | 30319-3020
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Country | US
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Telephone | 404-261-0260
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Fax | 404-844-0373
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Provider Business Mailing Address
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Address Line | 4060 PEACHTREE ROAD, N.E. SUITE H
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City | ATLANTA
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State | GA
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Zip | 30319-3020
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Country | US
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Telephone | 404-261-0260
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Fax | 404-844-0373
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS JOHN MICHAELS
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Credential | D.M.D.
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Telephone | 404-261-0260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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