Provider Demographics
NPI:1992977615
Name:CHILDREN'S DENTAL CARE CENTER, PC
Entity type:Organization
Organization Name:CHILDREN'S DENTAL CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-323-1280
Mailing Address - Street 1:5000 SNAPFINGER WOODS DR
Mailing Address - Street 2:SUITE B-210
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4085
Mailing Address - Country:US
Mailing Address - Phone:770-323-1280
Mailing Address - Fax:770-323-8622
Practice Address - Street 1:5000 SNAPFINGER WOODS DR
Practice Address - Street 2:SUITE B-210
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4085
Practice Address - Country:US
Practice Address - Phone:770-323-1280
Practice Address - Fax:770-323-8622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011370261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center