Provider Demographics
NPI:1386810836
Name:DENTAL ASSOCIATES OF BUCKHEAD, P.C.
Entity type:Organization
Organization Name:DENTAL ASSOCIATES OF BUCKHEAD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-261-3091
Mailing Address - Street 1:309 E PACES FERRY RD NE
Mailing Address - Street 2:SUITE 611
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2367
Mailing Address - Country:US
Mailing Address - Phone:404-261-3091
Mailing Address - Fax:404-261-0048
Practice Address - Street 1:309 E PACES FERRY RD NE
Practice Address - Street 2:SUITE 611
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2367
Practice Address - Country:US
Practice Address - Phone:404-261-3091
Practice Address - Fax:404-261-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0124541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty