Grant Park Dental Group PC
Dentist, General Practice in Atlanta, GA. Organization (NPI-2).
NPI number1679877005
StatusActive
Last updated in NPPESDec 28, 2010
Details
- NPI
- 1679877005
- Entity type
- Organization (NPI-2)
- Legal business name
- Grant Park Dental Group PC
- Organization subpart
- No
- Enumeration date
- Dec 28, 2010
- Last updated
- Dec 28, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | DN013218 | GA | Yes |
| 1223G0001X | Dentist, General Practice | DN012466 | GA |
Practice location
465 Boulevard Se Ste 207aAtlanta, GA 30312-3483
Phone 404-624-1230 · Fax 404-624-1210
Mailing address
465 Boulevard Se Ste 207aAtlanta, GA 30312-3483
Phone 404-624-1230 · Fax 404-624-1210
Authorized official
Ashish Pravin Vakharia
President
4127167907
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