Provider Demographics
NPI:1386953222
Name:DENTAL HEALTH ASSOCIATES ORAL SURGERY INC.
Entity type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES ORAL SURGERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-879-1177
Mailing Address - Street 1:2900 DELK RD SE STE 1450
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 DELK RD SE STE 1450
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5322
Practice Address - Country:US
Practice Address - Phone:770-951-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty