1821480724 NPI number — ATLAS DENTAL MANAGEMENT, LLC

Table of content: EMILY MARIA ROUNTREE MD (NPI 1477635605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821480724 NPI number — ATLAS DENTAL MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLAS DENTAL MANAGEMENT, 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:
6
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:
1821480724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4447 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
SUITE 110, PMB 434
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75205-4245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-215-6530
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4447 N CENTRAL EXPY
Provider Second Line Business Practice Location Address:
SUITE 110, PMB 434
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75205-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-215-6530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MUELLER
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
618-960-3684

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  24871 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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