1629406004 NPI number — VERDE POINTE DENTAL ASSOCIATES, LLC

Table of content: STEVEN EDWARD HARRIS BCBA (NPI 1750137832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629406004 NPI number — VERDE POINTE DENTAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERDE POINTE DENTAL ASSOCIATES, 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:
Provider Other Organization Name Type Code:
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:
1629406004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3698 LARGENT WAY NW
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30064-5923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-423-4900
Provider Business Mailing Address Fax Number:
770-590-8694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3698 LARGENT WAY NW
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30064-5923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-423-4900
Provider Business Practice Location Address Fax Number:
770-590-8694
Provider Enumeration Date:
10/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KIMMERLING
Authorized Official First Name:
KIRK
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
OWNER /DENTIST
Authorized Official Telephone Number:
770-423-4900

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DN013891 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: DN009687 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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