Avala Dental Providers,LLC
Organization Active NPI Point of Service · Lilburn, GA
NPI 1851729883 · NPPES record last updated Oct 30, 2013
Key facts
- NPI
- 1851729883
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Point of Service 305S00000X
- License
- DN014034 (GA)
- Legal business name
- AVALA DENTAL PROVIDERS,LLC
- Practice address
- 629 A Beaver Ruin Rd
Lilburn, GA 30047 - Phone
- (770) 696-4144
- Fax
- (470) 545-2859
- NPI assigned
- Oct 30, 2013
- Organization subpart
- No
Authorized official
- Name
- Ms. Tiffany N Jamison, DMD
- Title
- Owner
- Phone
- (770) 696-4144
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Point of Service | 305S00000X | DN014034 | GA | Yes |
Addresses
Primary practice location
629 A Beaver Ruin Rd
Lilburn, GA 30047
Mailing address
629 A Beaver Ruin Rd
Lilburn, GA 30047
Phone (770) 696-4144
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487953741 | Medicaid | GA |
Other names
- Polish Dental Center,LLC
Other providers in Lilburn, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.