Provider Demographics
NPI:1861736514
Name:SENOIA FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:SENOIA FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FALER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-289-0382
Mailing Address - Street 1:42 MAIN ST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-1889
Mailing Address - Country:US
Mailing Address - Phone:770-599-4441
Mailing Address - Fax:770-599-4442
Practice Address - Street 1:42 MAIN ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-1889
Practice Address - Country:US
Practice Address - Phone:770-599-4441
Practice Address - Fax:770-599-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127261223P0300X
GADN0127401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty