Active NPI
Van Pelt Rockefeller, DMD
- Dentist
- Roswell, GA
National Provider Identifier
1043408792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN015157
- Practice address
- 1178 Grimes Bridge Rd Ste 100
Roswell, GA 30075-3935 - Phone
- (770) 992-7550
- NPI assigned
- Oct 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT9110 | GA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | DN015157 | GA | Primary |
Addresses
Primary practice location
1178 Grimes Bridge Rd Ste 100
Roswell, GA 30075-3935
Mailing address
2885 Stonecreek Road
Smyrna, GA 30080
Phone (317) 529-4047
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN015157 | GA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smith & Rockefeller, PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Roswell, GA
- NPI 1093873739
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470700800000",
"number": "1043408792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2885 STONECREEK ROAD",
"city": "SMYRNA",
"state": "GA",
"postal_code": "30080",
"telephone_number": "317-529-4047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1178 GRIMES BRIDGE RD STE 100",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300753935",
"telephone_number": "770-992-7550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROCKEFELLER",
"first_name": "VAN",
"middle_name": "PELT",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-09",
"last_updated": "2016-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT9110",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN015157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.