NPIMap

Organization Active NPI

Cedar Dental Clinical I, LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • McDonough, GA
National Provider Identifier
1003423039
Registry record updated Sep 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
CEDAR DENTAL CLINICAL I, LLC
Practice address
119 Willow LN
McDonough, GA 30253-6574
Phone
(678) 432-8505
Fax
(678) 432-9419
NPI assigned
Sep 24, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2020

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

Authorized official

Name
Mr. Henry Rankin Dallam III, DMD
Title
President
Phone
(770) 331-2529

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

119 Willow LN
McDonough, GA 30253-6574

Mailing address

6801 Governors Lake Pkwy Ste 290
Peachtree Corners, GA 30071-1136
Phone (678) 978-3099

Other identifiers 1

IdentifierTypeStateIssuer
DN013071OtherGAGA DENTAL LICENSE

Other names 1

  • Orthodontic Care of Georgia Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address asockwell@orthodonticcarega.com Direct

National Provider Directory

National Provider Directory
Tax ID family
Cedar Dental Clinical I LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

119 Willow Ln
McDonough, GA 30253
Phone (470) 593-7065

NPI Registry JSON

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

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1003423039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 GOVERNORS LAKE PKWY STE 290",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300711136",
            "telephone_number": "678-978-3099",
            "fax_number": "678-691-4425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 WILLOW LN",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536574",
            "telephone_number": "678-432-8505",
            "fax_number": "678-432-9419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR DENTAL CLINICAL I, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-24",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A",
        "authorized_official_last_name": "DALLAM",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "RANKIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-331-2529",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA DENTAL LICENSE",
            "identifier": "DN013071",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "asockwell@orthodonticcarega.com",
            "affiliation": "N",
            "endpointDescription": "direct email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "119 Willow Ln",
            "city": "McDonough",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302536574",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Orthodontic Care of Georgia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McDonough, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.