Provider Demographics
NPI:1699237511
Name:ATHENS FAMILY DENTAL
Entity type:Organization
Organization Name:ATHENS FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF INTEGRATION
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOESTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-675-3088
Mailing Address - Street 1:3483 COASTLINE LN
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6587
Mailing Address - Country:US
Mailing Address - Phone:954-675-3088
Mailing Address - Fax:
Practice Address - Street 1:746 TELL STREET
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303
Practice Address - Country:US
Practice Address - Phone:423-745-3559
Practice Address - Fax:423-507-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Single Specialty