Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Executive Park Dentistry, PC

Organization Dentist · NPI 1124373139

Executive Park Dentistry, PC provides Dentist services 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 Not confirmed with CMS for 14 years — call before visiting
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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