Provider Demographics
NPI:1154788313
Name:TOUCHSTONE ORTHODONTICS LLC
Entity type:Organization
Organization Name:TOUCHSTONE ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MERIDITH
Authorized Official - Middle Name:LONG
Authorized Official - Last Name:DAUTOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:404-983-0237
Mailing Address - Street 1:3350 RIVERWOOD PKWY SE
Mailing Address - Street 2:SUITE 2130
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6401
Mailing Address - Country:US
Mailing Address - Phone:770-850-9119
Mailing Address - Fax:
Practice Address - Street 1:3350 RIVERWOOD PKWY SE
Practice Address - Street 2:SUITE 2130
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6401
Practice Address - Country:US
Practice Address - Phone:770-850-9119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0122541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty