Provider Demographics
NPI:1023269099
Name:APPLE DENTAL CARE
Entity type:Organization
Organization Name:APPLE DENTAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MEHRON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-218-0218
Mailing Address - Street 1:50 ERNEST BARRETT PARKWAY NW
Mailing Address - Street 2:STE. 1410
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066
Mailing Address - Country:US
Mailing Address - Phone:770-218-0218
Mailing Address - Fax:770-218-0918
Practice Address - Street 1:50 ERNEST BARRETT PARKWAY NW
Practice Address - Street 2:STE 1410
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066
Practice Address - Country:US
Practice Address - Phone:770-218-0218
Practice Address - Fax:770-218-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty