Individual provider Active NPI

Heliodore Anatole Houenou, DDS

  • General Practice Dentistry
  • Lawrenceville, GA
National Provider Identifier
1053471698
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
012216 Issued in GA
Practice address
1790 Atkinston Road
BLDG 4, Ste B
Lawrenceville, GA 30043
Phone
(770) 962-4322
Fax
(678) 407-2787
NPI assigned
Dec 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 012216 GA Primary

Addresses

Primary practice location

1790 Atkinston Road
BLDG 4, Ste B
Lawrenceville, GA 30043

Mailing address

1790 Atkinston Road
Building 4, Suite B
Lawrenceville, GA 30043
Phone (770) 962-4322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250916003437 GA Practitioner - Dentist 5294046694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
University of Detroit Mercy School of Dentistry, 1998
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1790 Atkinson Rd
Lawrenceville, GA 30043-7988

1790 Atkinson Rd NW
Building 4 Suite B
Lawrenceville, GA 30043-7989

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
012216GAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Optima Dental PC General Practice CurrentSince Jun 4, 2010 Accepting new patients

Locations

4825 Sugarloaf Pkwy
Ste A
Lawrenceville, GA 30044
Phone (770) 609-6620

1790 Atkinson Rd
Ste B
Lawrenceville, GA 30043
Phone (770) 962-4322

4825 Sugarloaf Pkwy
Lawrenceville, GA 30044

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.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1053471698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 ATKINSTON ROAD",
            "address_2": "BUILDING 4, SUITE B",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30043",
            "telephone_number": "770-962-4322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 ATKINSTON ROAD",
            "address_2": "BLDG 4, STE B",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30043",
            "telephone_number": "770-962-4322",
            "fax_number": "678-407-2787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOUENOU",
        "first_name": "HELIODORE",
        "middle_name": "ANATOLE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "012216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.