Suwanee Station Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

012548 Issued in GA

Legal business name

SUWANEE STATION DENTISTRY, LLC

Practice address

1300 Peachtree Industrial Blvd
Suite 4103
Suwanee, GA 30024-4539

Phone

(770) 831-5568

Fax

(770) 831-5527

NPI assigned

Jun 6, 2010

Organization subpart

No

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

Authorized official

Name

Tara Perry

Title

Dentist

Phone

(770) 831-5568

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1275782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275782400000",
    "number": "1043530686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 4103",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244539",
            "telephone_number": "770-831-5568",
            "fax_number": "770-831-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 4103",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244539",
            "telephone_number": "770-831-5568",
            "fax_number": "770-831-5527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUWANEE STATION DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-06",
        "last_updated": "2010-06-06",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "770-831-5568"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "012548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suwanee Happy Chiropractic
• Suwanee Holistic Care
• Suwanee Internal Medicine
• Suwanee Medical Center
• Suwanee Pain Management Center Inc
• Parri La'Nae Swinson
• Diane Dolore Sykes, PSY.D.
• Danielle Sylvester, MS, OTR/L
• Sys6650
• Michael Sytsma

• General Practice Dentistry in Suwanee, GA
• Providers in Suwanee, 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 Jun 6, 2010; 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.