Organization
CUMMING DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN SHORT DDS (OWNER)
(770) 781-8650
Entity
Organization
Contact information
Practice address
1200 BALD RIDGE MARINA RD, SUITE 200, CUMMING, GA 30041-8494
(770) 781-8650
(770) 781-2953
Mailing address
PO BOX 599, CUMMING, GA 30028-0599
(770) 781-8650
(770) 781-2953
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN014775
GA
122300000X
Dentist
DN015174
GA
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
DN011242
GA
1223G0001X
General Practice Dentistry
DN011760
GA
1223G0001X
General Practice Dentistry
DN012306
GA
1223G0001X
General Practice Dentistry
DN012514
GA
1223G0001X
General Practice Dentistry
DN015212
GA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DN011424
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4080537
BC BS OF TN
TN
01
—
825012
UNITED CONCORDIA
GA
Enumeration date
03/14/2007
Last updated
03/17/2018
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