Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Executive Park Dentistry, PC

Organization Dentist · NPI 1124373139

Executive Park Dentistry, PC is a Dentist in Atlanta, Georgia. Licensed in Georgia. Registered with an NPI since 2012.

Licensed in
GA
In the registry since
2012
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

17 Executive Park Dr NE Ste 100
Atlanta, GA 30329-2251
Phone: (404) 633-0715
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence DN012967 (GA)

Record details

NPI number1124373139
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Omar Damji — Owner/Dentist · (404) 664-6876
NPI enumeratedJuly 16, 2012
Last updated in NPPESJuly 16, 2012
Mailing address17 Executive Park Dr Ne, Suite 100, Atlanta, GA 30329-2251

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