AVALA DENTAL PROVIDERSLLC NPI 1851729883

NPI Information

  • NPI: 1851729883
  • Provider Name: AVALA DENTAL PROVIDERS,LLC
  • Classification: Point of Service - 305S00000X
  • Entity Type: Organization
  • Doing Business As: POLISH DENTAL CENTER,LLC
  • Address: 629 A BEAVER RUIN RD
    LILBURN, GA
    ZIP 30047
  • Phone: (770) 696-4144

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NPI Details

AVALA DENTAL PROVIDERS,LLC is a point of service in Lilburn, GA. The provider is this product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. AVALA DENTAL PROVIDERS,LLC NPI is 1851729883. The provider is registered as an organization entity type.
The provider Is Doing Business As Polish Dental Center,llc.

The provider's business location address is:

629 A BEAVER RUIN RD
LILBURN, GA
ZIP 30047
Phone: (770) 696-4144
Fax: (470) 545-2859

The provider's authorized official is Tiffany N Jamison .
The authorized official title is Owner and has the following contact phone number (770) 696-4144.

The enumeration date for this NPI number is 10/30/2013 and was last updated on 10/30/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1305S00000XPoint of ServiceDN014034GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11487953741MEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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