Provider Demographics
NPI:1730591603
Name:DENTISTRY FOR MIDTOWN, LLC
Entity type:Organization
Organization Name:DENTISTRY FOR MIDTOWN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-249-1716
Mailing Address - Street 1:1401 PEACHTREE ST NE STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3005
Mailing Address - Country:US
Mailing Address - Phone:404-249-1716
Mailing Address - Fax:404-249-1716
Practice Address - Street 1:1401 PEACHTREE ST NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3005
Practice Address - Country:US
Practice Address - Phone:404-249-1716
Practice Address - Fax:404-249-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty