NPIMap

Organization Active NPI

Children's Dental Ctr at Brookstone

  • Pediatric Dentistry
  • Acworth, GA
National Provider Identifier
1013117878
Registry record updated Jul 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
CHILDREN'S DENTAL CTR AT BROOKSTONE
Practice address
1825 Mars Hill Rd NW
Acworth, GA 30101
Phone
(770) 422-9375
Fax
(770) 528-5976
NPI assigned
Jul 20, 2007
Last updated
Jul 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2007

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

Authorized official

Name
Maureen Ward Shealy
Title
Cfo
Phone
(770) 422-9375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X Primary

Addresses

Primary practice location

1825 Mars Hill Rd NW
Acworth, GA 30101

Mailing address

1825 Mars Hill Rd NW
Acworth, GA 30101
Phone (770) 422-9375

National Provider Directory

National Provider Directory

Locations

1010 N Tennessee St
Ste 1
Cartersville, GA 30120

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184889600000",
    "number": "1013117878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 MARS HILL RD NW",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "30101",
            "telephone_number": "770-422-9375",
            "fax_number": "770-528-5976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 MARS HILL RD NW",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "30101",
            "telephone_number": "770-422-9375",
            "fax_number": "770-528-5976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S DENTAL CTR AT BROOKSTONE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-20",
        "last_updated": "2007-07-20",
        "status": "A",
        "authorized_official_last_name": "SHEALY",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_middle_name": "WARD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "770-422-9375"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Acworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; 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.