Provider Demographics
NPI:1417764507
Name:PDAA 2 EVANS LLC
Entity type:Organization
Organization Name:PDAA 2 EVANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AKINDEKO
Authorized Official - Middle Name:
Authorized Official - Last Name:OBEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-849-8097
Mailing Address - Street 1:4250 WASHINGTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3351
Mailing Address - Country:US
Mailing Address - Phone:706-524-7628
Mailing Address - Fax:706-343-3995
Practice Address - Street 1:4250 WASHINGTON RD STE 1
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3351
Practice Address - Country:US
Practice Address - Phone:706-524-7628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty