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General NPI Number Information
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NPI Number | 1871853366
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL HARVEST DENTISTRY
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 5555 PEACHTREE DUNWOODY RD NE STE G73
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City | ATLANTA
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State | GA
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Zip | 30342-1787
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Country | US
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Telephone | 770-262-4096
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Fax | 404-256-0901
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Provider Business Mailing Address
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Address Line | 5555 PEACHTREE DUNWOODY RD NE STE G73
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City | ATLANTA
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State | GA
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Zip | 30342-1787
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Country | US
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Telephone | 770-262-4096
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Fax | 404-256-0901
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Authorized Official
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Title or Position | MANAGER
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Name | DR. GEORGE MARIUS DINULESCU
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Credential |
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Telephone | 770-262-4096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 11011
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License Number State | GA
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