Northeast Georgia Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN011850 Issued in GA

Legal business name

NORTHEAST GEORGIA DENTAL GROUP

Practice address

1200 Sherwood Park Dr NE
Gainesville, GA 30501-3445

Phone

(770) 532-4555

NPI assigned

May 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Richard G. Bennett

Title

Owner

Phone

(770) 532-4555

Specialties & licenses 1

Addresses

Tax ID family

BGW Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Northeast Georgia Dental Group

  • General Practice Dentistry
  • Braselton, GA
  • NPI 1063904076
  NPD tax ID

Locations

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1013121359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SHERWOOD PARK DR NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013445",
            "telephone_number": "770-532-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SHERWOOD PARK DR NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013445",
            "telephone_number": "770-532-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-532-4555",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN011850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Zoe Northcutt
• Northeast Georgia Cancer Specialist, PC
• Northeast Georgia Community Physicians LLC
• Northeast Georgia Community Physicians LLC
• Northeast Georgia Diagnostic Associates and Clinic, LLC
• Northeast Georgia Diagnostic Associates and Clinic, LLC
• Northeast Georgia Diagnostic Clinic LLC
• Northeast Georgia Gynecology
• Northeast Georgia Health Services

• General Practice Dentistry in Gainesville, GA
• Providers in Gainesville, 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 19, 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.