Provider Demographics
NPI:1942655816
Name:DENTAL RESCUE THERAPY GROUP, LLC
Entity type:Organization
Organization Name:DENTAL RESCUE THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYYAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:404-247-5970
Mailing Address - Street 1:39 VERNON GLEN CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5422
Mailing Address - Country:US
Mailing Address - Phone:404-247-5970
Mailing Address - Fax:
Practice Address - Street 1:39 VERNON GLEN CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5422
Practice Address - Country:US
Practice Address - Phone:404-247-5970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1223P0700X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty