MEDICARE: BUCKHEAD DENTAL ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	GA8628 GA10187GA9232	GA

General Provider Information

NPI Number	:	1073516662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKHEAD DENTAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	3340 PEACHTREE RD NE
Second Line	:	STE 1685
City	:	ATLANTA
State	:	GA
Zip	:	30326-1012
Country	:	US
Telephone Number	:	404-266-1300
Fax Number	:	404-365-8526

Provider Business Practice Location Address
First Line	:	3340 PEACHTREE RD NE
Second Line	:	STE 1685
City	:	ATLANTA
State	:	GA
Zip	:	30326-1012
Country	:	US
Telephone Number	:	404-266-1300
Fax Number	:	404-365-8526

Authorized Official
Title or Position	:	HIPAA COMPLIANCE OFFICER
Name	:	KRISTIN BENNINGER
Credential	:
Telephone Number	:	404-266-1300

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/22/2020

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