Provider Demographics
NPI:1538745914
Name:DULUTH DENTAL CLUB, PC
Entity type:Organization
Organization Name:DULUTH DENTAL CLUB, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-512-1070
Mailing Address - Street 1:2151 HUNTERS GREEN DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5181
Mailing Address - Country:US
Mailing Address - Phone:404-512-1070
Mailing Address - Fax:
Practice Address - Street 1:2003 RIVERSIDE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5941
Practice Address - Country:US
Practice Address - Phone:404-512-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DULUTH DENTAL CLUB, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental