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General NPI Number Information
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NPI Number | 1386810836
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Entity Type | Organization
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Legal Business Name | DENTAL ASSOCIATES OF BUCKHEAD, P.C.
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 309 E PACES FERRY RD NE SUITE 611
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City | ATLANTA
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State | GA
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Zip | 30305-2367
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Country | US
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Telephone | 404-261-3091
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Fax | 404-261-0048
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Provider Business Mailing Address
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Address Line | 309 E PACES FERRY RD NE SUITE 611
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City | ATLANTA
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State | GA
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Zip | 30305-2367
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Country | US
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Telephone | 404-261-3091
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Fax | 404-261-0048
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. LORI SPENCE
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Credential |
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Telephone | 404-261-3091
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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 | DN012454
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License Number State | GA
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