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General NPI Number Information
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NPI Number | 1730519901
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Entity Type | Organization
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Legal Business Name | HAVEN DENTAL CARE, P.C.
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Dates
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Enumeration Date | 11/25/2013
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 3312 PEACHTREE INDUSTRIAL BLVD SUITE 8
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City | DULUTH
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State | GA
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Zip | 30096-8100
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Country | US
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Telephone | 770-545-8647
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Fax |
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Provider Business Mailing Address
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Address Line | 3312 PEACHTREE INDUSTRIAL BLVD SUITE 8
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City | DULUTH
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State | GA
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Zip | 30096-8100
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Country | US
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Telephone | 770-545-8647
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS LEE
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Credential | DDS
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Telephone | 770-545-8647
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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 |
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License Number State |
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