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General NPI Number Information
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NPI Number | 1912005752
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Entity Type | Organization
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Legal Business Name | DENTFIRST, P.C.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 80 PERIMETER CENTER PLACE N.E. BLDG 2700
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City | ATLANTA
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State | GA
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Zip | 30346
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Country | US
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Telephone | 770-671-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 OAKBROOK DR. STE 440
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City | NORCROSS
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State | GA
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Zip | 30093
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Country | US
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Telephone | 770-446-8000
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Fax | 770-446-1354
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Authorized Official
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Title or Position | CONTRACTS, CREDENTIALING MGR
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Name | GINA S JACKSON
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Credential |
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Telephone | 770-446-8000
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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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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7981
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License Number State | GA
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