Warren Kritsanachaiwanich, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN123359 Issued in GA

Practice address

3466 Cobb Pkwy NW Ste 170
Acworth, GA 30101-5768

Phone

(770) 203-1711

NPI assigned

Jul 16, 2020

Last updated

Jul 14, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720915200000",
    "number": "1003424920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 FERRARI DR",
            "city": "LEANDER",
            "state": "TX",
            "postal_code": "786413899",
            "telephone_number": "770-906-4175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3466 COBB PKWY NW STE 170",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301015768",
            "telephone_number": "770-203-1711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2312 Western Trails Blvd",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787451642",
            "country_code": "US",
            "telephone_number": "512-326-2476",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRITSANACHAIWANICH",
        "first_name": "WARREN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-16",
        "last_updated": "2024-07-14",
        "certification_date": "2024-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "36323",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN123359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.westerntrailsdental.com/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Office",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Office",
            "address_1": "2312 Western Trails Blvd",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787451642",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://acworthdentalcenter.com/?y_source=1_MTE1OTM1OTMtNzE1LWxvY2F0aW9uLndlYnNpdGU%3D",
            "affiliation": "N",
            "address_1": "3466 Cobb Pkwy NW Ste 170",
            "city": "Acworth",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301015768",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• General Practice Dentistry in Acworth, GA
• Providers in Acworth, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2024; 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.