Provider Demographics
NPI:1528239548
Name:DYNASTY DENTAL CARE INC.
Entity type:Organization
Organization Name:DYNASTY DENTAL CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KALANTAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-993-9048
Mailing Address - Street 1:1096 ALPHARETTA STREET
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1096 ALPHARETTA ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3632
Practice Address - Country:US
Practice Address - Phone:770-993-9048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0124451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty