Provider Demographics
NPI:1730519901
Name:HAVEN DENTAL CARE, P.C.
Entity type:Organization
Organization Name:HAVEN DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-545-8647
Mailing Address - Street 1:3312 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8100
Mailing Address - Country:US
Mailing Address - Phone:770-545-8647
Mailing Address - Fax:
Practice Address - Street 1:3312 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8100
Practice Address - Country:US
Practice Address - Phone:770-545-8647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty