Provider Demographics
NPI:1124255302
Name:MORRISON DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:MORRISON DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONTEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-235-3611
Mailing Address - Street 1:4536 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6200
Mailing Address - Country:US
Mailing Address - Phone:770-455-1238
Mailing Address - Fax:678-990-9799
Practice Address - Street 1:4536 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6200
Practice Address - Country:US
Practice Address - Phone:770-455-1238
Practice Address - Fax:678-990-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty