Darryl H. Eaton, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN010540 Issued in GA

Practice address

798 Rays Rd Ste 101
Stone Mountain, GA 30083-3144

Phone

(404) 294-1050

Fax

(404) 294-4804

NPI assigned

Nov 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 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": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219276800000",
    "number": "1013084094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "798 RAYS RD STE 101",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833144",
            "telephone_number": "404-294-1050",
            "fax_number": "404-294-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "798 RAYS RD STE 101",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833144",
            "telephone_number": "404-294-1050",
            "fax_number": "404-294-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EATON",
        "first_name": "DARRYL",
        "middle_name": "H.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN010540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168950874A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168950874K",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Stone Mountain, GA
• Providers in Stone Mountain, 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 Aug 21, 2008; 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.