Provider Demographics
NPI:1699314955
Name:LAIL FAMILY DENTISTRY P.C.
Entity type:Organization
Organization Name:LAIL FAMILY DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SLADE
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-772-5640
Mailing Address - Street 1:PO BOX 1476
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-0026
Mailing Address - Country:US
Mailing Address - Phone:770-476-2400
Mailing Address - Fax:
Practice Address - Street 1:3415 HIGHWAY 120
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3354
Practice Address - Country:US
Practice Address - Phone:770-476-2400
Practice Address - Fax:770-623-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1538482377OtherLISA MOSS
GA1790213825OtherDEVAN CALLAWAY
GA1881981181OtherSWL DENTAL
GA1821263831OtherWALLACE LAIL
GA1902997109OtherSLADE LAIL