1437412889 NPI number — HAMILTON MILL ORAL AND FACIAL SURGERY, 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 1437412889 NPI number — HAMILTON MILL ORAL AND FACIAL SURGERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMILTON MILL ORAL AND FACIAL SURGERY, 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:
YADIRA CARDONA-ROHENA, DMD
Provider Other Organization Name Type Code:
5
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:
1437412889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4285 JIM MOORE RD
Provider Second Line Business Mailing Address:
BLDG 100, SUITE 104
Provider Business Mailing Address City Name:
DACULA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30019-1609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-835-1135
Provider Business Mailing Address Fax Number:
678-835-1136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4285 JIM MOORE RD
Provider Second Line Business Practice Location Address:
BLDG 100, SUITE 104
Provider Business Practice Location Address City Name:
DACULA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30019-1609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-835-1135
Provider Business Practice Location Address Fax Number:
678-835-1136
Provider Enumeration Date:
06/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CARDONA-ROHENA
Authorized Official First Name:
YADIRA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND DOCTOR
Authorized Official Telephone Number:
678-835-1135

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  DN013477 , 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)





Copyright © 2007-2024 www.npivalidator.com