1497007991 NPI number — FEATHER TOUCH DENTAL CARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497007991 NPI number — FEATHER TOUCH DENTAL CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FEATHER TOUCH DENTAL CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FEATHER TOUCH DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497007991
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1175 PEACHTREE ST NE
Provider Second Line Business Mailing Address:
SUITE 1204
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30361-3528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-892-2097
Provider Business Mailing Address Fax Number:
866-318-6029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1175 PEACHTREE ST NE
Provider Second Line Business Practice Location Address:
SUITE 1204
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30361-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-892-2097
Provider Business Practice Location Address Fax Number:
866-318-6029
Provider Enumeration Date:
10/08/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANNING
Authorized Official First Name:
CARLISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
404-879-6634

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7099 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: DN013903 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)