1821394511 NPI number — KENNESTONE PERIODONTICS AT WINDY HILL, PC

Table of content: (NPI 1821394511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821394511 NPI number — KENNESTONE PERIODONTICS AT WINDY HILL, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNESTONE PERIODONTICS AT WINDY HILL, PC
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:
LEE H SILVERSTEIN, DDS MS PC
Provider Other Organization Name Type Code:
4
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:
1821394511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2070 S PARK PL SE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-2045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-952-5432
Provider Business Mailing Address Fax Number:
770-952-3011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2070 S PARK PL SE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30339-2045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-952-5432
Provider Business Practice Location Address Fax Number:
770-952-3011
Provider Enumeration Date:
01/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SILVERSTEIN
Authorized Official First Name:
LEE
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-952-5432

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  10742 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0300X , with the licence number: 11384 , 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)

  • Identifier: 1811082183 . This is a "PROVIDER NPI NUMBER - SILVERSTEIN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1982798716 . This is a "PERSONAL NPI NUMBER - SHATZ" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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