Provider Demographics
NPI:1194281774
Name:METROPOLITAN DENTAL & MEDICAL CLINIC INC
Entity type:Organization
Organization Name:METROPOLITAN DENTAL & MEDICAL CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:CDT
Authorized Official - Phone:770-837-9293
Mailing Address - Street 1:1720 OLD SPRING HOUSE LN STE 315
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6215
Mailing Address - Country:US
Mailing Address - Phone:770-837-9293
Mailing Address - Fax:770-837-9243
Practice Address - Street 1:1720 OLD SPRING HOUSE LN STE 315
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6215
Practice Address - Country:US
Practice Address - Phone:770-837-9293
Practice Address - Fax:770-837-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
No2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical ToxicologyGroup - Multi-Specialty