NPIMap

Organization Active NPI

Comprehensive Aesthetic & Restorative Dentistry LLC

Doing business as Dentistry Of Olde Towne

  • General Practice Dentistry
  • Woodstock, GA
National Provider Identifier
1023149507
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN012537 Issued in GA
Legal business name
COMPREHENSIVE AESTHETIC & RESTORATIVE DENTISTRY LLC
Doing business as
Dentistry Of Olde Towne
Practice address
113 Towne Lake Pkwy
Ste 110
Woodstock, GA 30188
Phone
(770) 928-3055
Fax
(770) 928-1255
NPI assigned
Mar 8, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Christopher Lee Rautenstrauch, DMDNPI 1396876785
Title
Owner LLC Member
Phone
(770) 928-3055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN012537 GA Primary
General Practice Dentistry 1223G0001X 9445 GA

Addresses

Primary practice location

113 Towne Lake Pkwy
Ste 110
Woodstock, GA 30188

Mailing address

113 Towne Lake Pkwy
Ste 110
Woodstock, GA 30188
Phone (770) 928-3055

Other names 1

  • Dentistry Of Olde Towne Doing business as

National Provider Directory

National Provider Directory

Locations

113 Towne Lake Pkwy
Ste 110
Woodstock, GA 30188
Phone (770) 928-3055

Practitioners & affiliated clinicians

Practitioners 3

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": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023149507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 TOWNE LAKE PKWY",
            "address_2": "STE 110",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "30188",
            "telephone_number": "770-928-3055",
            "fax_number": "770-928-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 TOWNE LAKE PKWY",
            "address_2": "STE 110",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "30188",
            "telephone_number": "770-928-3055",
            "fax_number": "770-928-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE AESTHETIC & RESTORATIVE DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RAUTENSTRAUCH",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER LLC MEMBER",
        "authorized_official_telephone_number": "770-928-3055",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012537",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "9445",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentistry Of Olde Towne",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodstock, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.