Provider Demographics
NPI:1730243510
Name:THOMAS CROSSROADS DENTAL CENTER INC.
Entity type:Organization
Organization Name:THOMAS CROSSROADS DENTAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:FERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-251-6676
Mailing Address - Street 1:2511 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1329
Mailing Address - Country:US
Mailing Address - Phone:770-251-6676
Mailing Address - Fax:770-251-0567
Practice Address - Street 1:2511 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1329
Practice Address - Country:US
Practice Address - Phone:770-251-6676
Practice Address - Fax:770-251-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8855261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental