Provider Demographics
NPI:1912605734
Name:ATLANTIC DENTAL SERVICES INC.
Entity type:Organization
Organization Name:ATLANTIC DENTAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAIVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-891-6900
Mailing Address - Street 1:8401 VAN NUYS BLVD UNIT 26
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3360
Mailing Address - Country:US
Mailing Address - Phone:818-891-6900
Mailing Address - Fax:
Practice Address - Street 1:8401 VAN NUYS BLVD UNIT 26
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3360
Practice Address - Country:US
Practice Address - Phone:818-891-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty