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Organization
ITARUT DENTAL LLC
Active
Organization
ITARUT DENTAL LLC
Active
Other names
Northlake Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PIYANUT ITARUT DMD (ORGANIZER)
(618) 977-6071
Entity
Organization
Contact information
Practice address
3756 LA VISTA RD, SUITE 102, TUCKER, GA 30084-5642
(404) 636-4700
Mailing address
3756 LA VISTA RD, SUITE 102, TUCKER, GA 30084-5642
(404) 636-4700
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/24/2019
Last updated
01/24/2019
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