NPIMap

Organization Active NPI

Cornelia Dental, LLC

  • Dental Clinic/Center
  • Cornelia, GA
National Provider Identifier
1023435310
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DN009940 Issued in GA
Legal business name
CORNELIA DENTAL, LLC
Practice address
105 Highland Ave
Cornelia, GA 30531-4366
Phone
(706) 778-8645
Fax
(706) 776-2650
NPI assigned
Mar 25, 2014
Last updated
Mar 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2014

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

Authorized official

Name
Dr. Ralph Leon Jackson, DDSNPI 1508869231
Title
Owner
Phone
(706) 778-8645

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X DN009940 GA Primary

Addresses

Primary practice location

105 Highland Ave
Cornelia, GA 30531-4366

Mailing address

105 Highland Ave
Cornelia, GA 30531-4366
Phone (706) 778-8645

National Provider Directory

National Provider Directory

Locations

105 Highland Ave
Cornelia, GA 30531
Phone (706) 778-8645

Practitioners & affiliated clinicians

Practitioners 4

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": "1395705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395705600000",
    "number": "1023435310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 HIGHLAND AVE",
            "city": "CORNELIA",
            "state": "GA",
            "postal_code": "305314366",
            "telephone_number": "706-778-8645",
            "fax_number": "706-776-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 HIGHLAND AVE",
            "city": "CORNELIA",
            "state": "GA",
            "postal_code": "305314366",
            "telephone_number": "706-778-8645",
            "fax_number": "706-776-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELIA DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-25",
        "last_updated": "2014-03-25",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "LEON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-778-8645",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "DN009940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cornelia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.