Organization Active NPI

Damian Sommerville, DDS

  • General Practice Dentistry
  • Marietta, GA
National Provider Identifier
1003291329
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN014899 Issued in GA
Legal business name
DAMIAN SOMMERVILLE, DDS
Practice address
1951 Canton Rd
Ste 310
Marietta, GA 30066-6327
Phone
(770) 423-0324
NPI assigned
Jul 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Damian L Sommerville, DDS
Title
Owner
Phone
(770) 423-0324

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN014899 GA Primary

Addresses

Primary practice location

1951 Canton Rd
Ste 310
Marietta, GA 30066-6327

Mailing address

1951 Canton Rd
Ste 310
Marietta, GA 30066-6327
Phone (770) 423-0324

Other identifiers 1

IdentifierTypeStateIssuer
003160400AMedicaidGA

National Provider Directory

National Provider Directory

Locations

1951 Canton Rd
Ste 310
Marietta, GA 30066
Phone (770) 423-0324

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1003291329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1951 CANTON RD",
            "address_2": "STE 310",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300666327",
            "telephone_number": "770-423-0324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1951 CANTON RD",
            "address_2": "STE 310",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300666327",
            "telephone_number": "770-423-0324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAMIAN SOMMERVILLE, DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-28",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "SOMMERVILLE",
        "authorized_official_first_name": "DAMIAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-423-0324",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN014899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003160400A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.