Provider Demographics
NPI:1427462720
Name:ICARE KIDS DENTISTRY INC.
Entity type:Organization
Organization Name:ICARE KIDS DENTISTRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-609-6106
Mailing Address - Street 1:1568 INDIAN TRAIL LILBURN RD # 201
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2613
Mailing Address - Country:US
Mailing Address - Phone:770-609-6106
Mailing Address - Fax:770-573-2987
Practice Address - Street 1:1568 INDIAN TRAIL LILBURN RD # 201
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2613
Practice Address - Country:US
Practice Address - Phone:770-609-6106
Practice Address - Fax:770-573-2987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty