Basic Information
| Provider Information | |||||||||
| NPI: | 1649867011 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHNS CREEK DENTAL STUDIO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 17TH ST NW UNIT 2409 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303631255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788496131 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5455 MCGINNIS VILLAGE PL STE 103 | ||||||||
| Address2: | |||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300051741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707511500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2020 | ||||||||
| LastUpdateDate: | 12/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | PARIKH | ||||||||
| AuthorizedOfficialFirstName: | ARJUN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6788496131 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.