Provider Demographics
NPI:1538728787
Name:K2 DENTAL, INC.
Entity type:Organization
Organization Name:K2 DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-868-0088
Mailing Address - Street 1:916 LOGANVILLE HWY STE 180
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-2162
Mailing Address - Country:US
Mailing Address - Phone:770-868-0088
Mailing Address - Fax:770-868-0119
Practice Address - Street 1:916 LOGANVILLE HWY STE 180
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-2162
Practice Address - Country:US
Practice Address - Phone:770-868-0088
Practice Address - Fax:770-868-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental