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NPI Code Detail

MEDICARE: INNOVATION DENTAL CARE LLC

MEDICARE: INNOVATION DENTAL CARE LLC
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1942165360
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNOVATION DENTAL CARE LLC
Provider Business Mailing Address
First Line : 2607 GILLIONVILLE RD
Second Line :
City : ALBANY
State : GA
Zip : 31707-3003
Country : US
Telephone Number : 615-364-4273
Fax Number :
Provider Business Practice Location Address
First Line : 2607 GILLIONVILLE RD
Second Line :
City : ALBANY
State : GA
Zip : 31707-3003
Country : US
Telephone Number : 615-364-4273
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. LARRY DAVIS
Credential :
Telephone Number : 229-340-5670
Provider Enumeration Date : 12/18/2025
Last Update Date : 01/12/2026

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Directions to “INNOVATION DENTAL CARE LLC ” Practice Location

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