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NPI Code Detail

MEDICARE: GRANT PARK DENTAL GROUP PC

MEDICARE: GRANT PARK DENTAL GROUP PC
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
11223G0001XGeneral Practice DentistryDN012466GA
21223G0001XGeneral Practice DentistryDN013218GA

General Provider Information

NPI Number : 1679877005
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANT PARK DENTAL GROUP PC
Provider Business Mailing Address
First Line : 465 BOULEVARD SE STE 207A
Second Line :
City : ATLANTA
State : GA
Zip : 30312-3483
Country : US
Telephone Number : 404-624-1230
Fax Number : 404-624-1210
Provider Business Practice Location Address
First Line : 465 BOULEVARD SE STE 207A
Second Line :
City : ATLANTA
State : GA
Zip : 30312-3483
Country : US
Telephone Number : 404-624-1230
Fax Number : 404-624-1210
Authorized Official
Title or Position : PRESIDENT
Name : ASHISH PRAVIN VAKHARIA
Credential : DMD
Telephone Number : 412-716-7907
Provider Enumeration Date : 12/28/2010
Last Update Date : 12/28/2010

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Directions to “GRANT PARK DENTAL GROUP PC ” Practice Location

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