Provider Demographics
NPI:1548973878
Name:ATLANTA WEST PERIODNTICS AND DENTAL IMPLANTS, PC
Entity type:Organization
Organization Name:ATLANTA WEST PERIODNTICS AND DENTAL IMPLANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONG THAO
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:832-566-7358
Mailing Address - Street 1:2168 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2638
Mailing Address - Country:US
Mailing Address - Phone:770-739-5097
Mailing Address - Fax:
Practice Address - Street 1:2168 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2638
Practice Address - Country:US
Practice Address - Phone:770-739-5097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty