Provider Demographics
NPI:1316072135
Name:DRUID HILLS DENTAL SERVICES
Entity type:Organization
Organization Name:DRUID HILLS DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:F
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-634-7559
Mailing Address - Street 1:2910 N DRUID HILLS RD NE
Mailing Address - Street 2:SUITE K
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3919
Mailing Address - Country:US
Mailing Address - Phone:404-634-7559
Mailing Address - Fax:404-325-9858
Practice Address - Street 1:2910 N DRUID HILLS RD NE
Practice Address - Street 2:SUITE K
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3919
Practice Address - Country:US
Practice Address - Phone:404-634-7559
Practice Address - Fax:404-325-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty