Provider Demographics
NPI:1336938224
Name:BROOKHAVEN DENTAL ASSOCIATES
Entity type:Organization
Organization Name:BROOKHAVEN DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ERLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-971-3889
Mailing Address - Street 1:1407 DRESDEN DR NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3580
Mailing Address - Country:US
Mailing Address - Phone:404-971-3889
Mailing Address - Fax:
Practice Address - Street 1:1407 DRESDEN DR NE STE 200
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3580
Practice Address - Country:US
Practice Address - Phone:404-971-3889
Practice Address - Fax:678-399-2094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1255385696OtherDR. ROMAN CIBIRKA
OH1538547872OtherDR. LUSHA XU