Provider Demographics
NPI:1902073513
Name:MIDTOWN DENTAL CENTER
Entity Type:Organization
Organization Name:MIDTOWN DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-874-0800
Mailing Address - Street 1:650 PONCE DE LEON AVE NE
Mailing Address - Street 2:SUITE 600 B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1804
Mailing Address - Country:US
Mailing Address - Phone:404-874-0800
Mailing Address - Fax:
Practice Address - Street 1:650 PONCE DE LEON AVE NE
Practice Address - Street 2:SUITE 600 B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1804
Practice Address - Country:US
Practice Address - Phone:404-874-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1174741953Medicaid
GA1003030941Medicaid
GA1720169451Medicaid