Carrollton Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN012710 Issued in GA

Legal business name

CARROLLTON FAMILY DENTISTRY

Practice address

101 Clinic Ave
Carrollton, GA 30117-4413

Phone

(770) 832-1376

NPI assigned

Jan 17, 2007

Last updated

Oct 6, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Patricia Sims

Title

Office Manager

Phone

(770) 439-2550

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Derek Deshan Mason, DDS

  • Pediatric Dentistry
  • Hiram, GA
  • NPI 1679566475
  NPD (past)

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317859200000",
    "number": "1003968496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 ENTERPRISE PATH",
            "address_2": "SUITE #106",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "30141",
            "telephone_number": "770-832-1376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CLINIC AVE",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174413",
            "telephone_number": "770-832-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARROLLTON FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2011-10-06",
        "status": "A",
        "authorized_official_last_name": "SIMS",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-439-2550",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044992718D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrollton Cypress LLC (Carrollton Nursing and Rehabilitation Center)
• Carrollton Ear, Nose and Throat, P.C.
• Carrollton Emergency Physicians, PC
• Carrollton Eye Clinic, P.C. (CARROLLTON EYE CLINIC and SURGERY CENTER)
• Carrollton Eye Clinic, PC
• Carrollton Family Dentistry LLC
• Carrollton Manor Inc
• Carrollton Optics LLC
• Carrollton Orthopaedic Clinic PC (Carrollton Orthopaedic Clinic)
• Carrollton Orthopaedic Clinic PC (Orthowest)

• General Practice Dentistry in Carrollton, GA
• Providers in Carrollton, 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 Oct 6, 2011; 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.