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General NPI Number Information
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NPI Number | 1154454171
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Entity Type | Organization
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Legal Business Name | DENTAL ONE ASSOCIATES (COLLEGE PARK) LLC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 02/22/2011
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Provider Practice Location Address
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Address Line | 1901 PHOENIX BLVD # 100
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City | ATLANTA
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State | GA
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Zip | 30349-5588
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Country | US
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Telephone | 770-991-0913
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 PHOENIX BLVD # 100
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City | ATLANTA
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State | GA
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Zip | 30349-5588
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INSURANCE DIRECTOR
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Name | MIKE COLE
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Credential |
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Telephone | 727-726-1611
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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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