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General NPI Number Information
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NPI Number | 1396956835
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Entity Type | Organization
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Legal Business Name | ATLANTA DENTAL GROUP PC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1624 PIEDMONT AVE NE
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City | ATLANTA
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State | GA
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Zip | 30324-5240
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Country | US
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Telephone | 404-874-7428
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Fax | 770-641-7827
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Provider Business Mailing Address
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Address Line | 1624 PIEDMONT AVE NE
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City | ATLANTA
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State | GA
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Zip | 30324-5240
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Country | US
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Telephone | 404-874-7428
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Fax | 770-641-7827
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK ALLAN PADOLSKY
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Credential | DDS
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Telephone | 404-874-7428
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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 | GA9576
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License Number State | GA
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