Provider Demographics
NPI:1902973498
Name:C. CELESTE COGGIN, D.M.D., P.C.
Entity Type:Organization
Organization Name:C. CELESTE COGGIN, D.M.D., P.C.
Other - Org Name:CELESTE COGGIN, D.M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:COGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DMD
Authorized Official - Phone:770-953-6666
Mailing Address - Street 1:2024 POWERS FERRY RD SE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5049
Mailing Address - Country:US
Mailing Address - Phone:770-953-6666
Mailing Address - Fax:770-952-5842
Practice Address - Street 1:2024 POWERS FERRY RD SE
Practice Address - Street 2:SUITE 190
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5049
Practice Address - Country:US
Practice Address - Phone:770-953-6666
Practice Address - Fax:770-952-5842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty