NPIMap

Organization Active NPI

Augusta Smiles Youth Dentistry, PC

  • General Practice Dentistry
  • Augusta, GA
National Provider Identifier
1033184643
Registry record updated Mar 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
AUGUSTA SMILES YOUTH DENTISTRY, PC
Practice address
1631 Gordon Hwy
Suite #22
Augusta, GA 30906-2292
Phone
(706) 790-9302
Fax
(706) 790-9303
NPI assigned
Feb 18, 2006
Last updated
Mar 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2015

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

Authorized official

Name
Mrs. Jenell Stump
Title
Director, Licensing & Credentialing
Phone
(706) 790-9302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

1631 Gordon Hwy
Suite #22
Augusta, GA 30906-2292

Mailing address

1631 Gordon Hwy Ste 22
Augusta, GA 30906-2230
Phone (706) 790-9302

Other identifiers 4

IdentifierTypeStateIssuer
ZAG978MedicaidSC
1770568OtherGAUNITED CONCORDIA
302137931AMedicaidGA
539114OtherGAAVESIS GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1140220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427328000000",
    "number": "1033184643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1631 GORDON HWY STE 22",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309062230",
            "telephone_number": "706-790-9302",
            "fax_number": "706-790-9303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 GORDON HWY",
            "address_2": "SUITE #22",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309062292",
            "telephone_number": "706-790-9302",
            "fax_number": "706-790-9303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTA SMILES YOUTH DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-18",
        "last_updated": "2015-03-26",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "DIRECTOR, LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "706-790-9302",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZAG978",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1770568",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "302137931A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS GA",
            "identifier": "539114",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; 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.