Provider Demographics
NPI:1861708802
Name:CUMBERLAND FAMILY DENTAL, LLC
Entity type:Organization
Organization Name:CUMBERLAND FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUNIYOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-272-1818
Mailing Address - Street 1:100 GALLERIA PKWY SE STE 670
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5947
Mailing Address - Country:US
Mailing Address - Phone:770-272-1818
Mailing Address - Fax:770-272-1817
Practice Address - Street 1:100 GALLERIA PKWY SE STE 670
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5947
Practice Address - Country:US
Practice Address - Phone:770-272-1818
Practice Address - Fax:770-272-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty