Provider Demographics
NPI:1154194868
Name:HIAWASSEE FAMILY DENTAL, LLC
Entity type:Organization
Organization Name:HIAWASSEE FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-312-1851
Mailing Address - Street 1:10445 NW 50TH PL
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1737
Mailing Address - Country:US
Mailing Address - Phone:954-675-3088
Mailing Address - Fax:
Practice Address - Street 1:19 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3433
Practice Address - Country:US
Practice Address - Phone:706-896-1204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty