PROFESSIONAL DENTAL ALLIANCE OF LILBURN, LLC (NPI# 1710544960) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710544960 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL DENTAL ALLIANCE OF LILBURN, LLC |
| Practice Address |
3970 Five Forks Trickum Rd Sw Ste B Lilburn GA 30047-2339 |
| Mailing Address |
11 S Mill St Ste 200 New Castle PA 16101-3680 |
| Practice Telephone | 7709218442 |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2019-05-23 |
| Authorized Official Name | JESSICA BARRETTE (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 7246982997 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Street Address |
3970 FIVE FORKS TRICKUM RD SW STE B |
| City | LILBURN |
| State | GA |
| Zip Code | 30047-2339 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750861217 | Latrina S Walden | Nurse Practitioner | 887 Ryan Lane, Lilburn, GA 30047 | 2018-08-15 |
| 1811483928 | Olivia Oyegunle | Optometrist | 4153 Lawrenceville Hwy Nw Ste 5, Lilburn, GA 30047 | 2018-07-02 |
| 1932619285 | Mpm Creative, LLC | Speech-Language Pathologist | 1560 Hewatt Rd, Lilburn, GA 30047 | 2017-10-01 |
| 1528515186 | Smith Dental Care of Lilburn, Inc. | Dentist | 3100 Five Forks Trickham Rd Suite 201, Lilburn, GA 30047 | 2016-09-01 |
| 1891143244 | Choices Behavioral Alternatives | Counselor | 4037 Darling Court, Suite B, Lilburn, GA 30047 | 2016-05-26 |
| 1235595687 | Georgia Dental Associates | Clinic/Center | 3100 Five Forks Trickum Road Suite 201, Lilburn, GA 30047 | 2016-01-14 |
| 1912382144 | Sangeetha Asokan | Dentist | 609, Beaver Ruin Road, Tebo Dental for Kids, Lilburn, GA 30047 | 2015-07-29 |
| 1467836403 | Pamela Neal | Registered Nurse | 3315 Landingview Ct, Lilburn, GA 30047 | 2015-07-18 |
| 1699172452 | Josie Kou, Kulah Curran | Registered Nurse | 3708 Tamer Ln, Lilburn, GA 30047 | 2014-11-21 |
| 1184039380 | Cheryl Lee | Chiropractor | 5014 Stone Mountain Hwy, Suite C, Lilburn, GA 30047 | 2014-06-25 |
| Find all providers in zip 30047 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548810997 | Stone Mountain Dental 2, PC | Dentist | 3100 Five Forks Trickum Rd Sw Ste 402, Lilburn, GA 30047-1887 | 2019-09-18 |
| 1619482635 | Affordable Dental Care, LLC | Dentist | 3993 Lawrenceville Hwy Nw Ste 100a, Lilburn, GA 30047-2831 | 2017-12-13 |
| 1528515186 | Smith Dental Care of Lilburn, Inc. | Dentist | 3100 Five Forks Trickham Rd Suite 201, Lilburn, GA 30047 | 2016-09-01 |
| 1609100015 | Platinum Dental Group Lilburn, LLC | Dentist | 609 Beaver Ruin Rd, Suite A, Lilburn, GA 30047 | 2009-10-01 |
| 1326289992 | William George Brandenburg | Dentist | 4068 Five Forks Trickum Rd Sw, Lilburn, GA 30047-2341 | 2009-03-11 |
| 1023271186 | Thaddeus Harvey Jr. | Dentist | 331 Arcado Rd Nw, Lilburn, GA 30047-2814 | 2008-07-08 |
| 1992907802 | Jeffrey Stephen Smith | Dentist | 3100 Five Forks Trickum Rd Sw, Bldg 5, Suite 501, Lilburn, GA 30047-1890 | 2007-06-03 |
| 1336261221 | Eric Mcguire Staeben | Dentist | 3993 Lawrenceville Hwy, Suite 100a, Lilburn, GA 30047-2831 | 2007-04-04 |
| 1447379995 | David P Marion | Dentist | 629 Beaver Ruin Rd Nw Ste A, Lilburn, GA 30047-3437 | 2007-03-28 |
| 1154448850 | Platinum Dental of Lilburn | Dentist | 609 Beaver Ruin Rd Nw Ste A, Lilburn, GA 30047-3401 | 2007-03-26 |
| Find all providers in LILBURN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.