Provider Demographics
NPI:1104451160
Name:SNO HEALTHCARE GROUP
Entity type:Organization
Organization Name:SNO HEALTHCARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-905-6004
Mailing Address - Street 1:2424 ROSWELL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4719
Mailing Address - Country:US
Mailing Address - Phone:678-905-6004
Mailing Address - Fax:
Practice Address - Street 1:2424 ROSWELL RD STE 120
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062
Practice Address - Country:US
Practice Address - Phone:678-905-6004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental