Provider Demographics
NPI:1588242853
Name:ADVANCED DENTISTRY OF NORTH ATLANTA
Entity type:Organization
Organization Name:ADVANCED DENTISTRY OF NORTH ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR/OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALISSA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GIANFALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-500-8446
Mailing Address - Street 1:3500 DULUTH PARK LN STE 100
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3230
Mailing Address - Country:US
Mailing Address - Phone:770-476-4140
Mailing Address - Fax:
Practice Address - Street 1:3500 DULUTH PARK LN STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3230
Practice Address - Country:US
Practice Address - Phone:770-476-4140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty