Basic Information
| Provider Information | |||||||||
| NPI: | 1952655581 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MH ORTHODONTICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 TOWNPARK DR NW | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301445803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704208462 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1030 W GORDON AVE STE A | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317014515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2294329555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2012 | ||||||||
| LastUpdateDate: | 11/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | CRYSTAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7704208462 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.