Provider Demographics
NPI:1427659028
Name:MY EMERGENCY DENTAL GA LLC
Entity type:Organization
Organization Name:MY EMERGENCY DENTAL GA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:470-523-8118
Mailing Address - Street 1:4811 LOWER ROSWELL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4345
Mailing Address - Country:US
Mailing Address - Phone:470-523-8118
Mailing Address - Fax:
Practice Address - Street 1:4811 LOWER ROSWELL RD STE 108
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4345
Practice Address - Country:US
Practice Address - Phone:470-523-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY EMERGENCY DENTAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty