NPIMap

Organization Active NPI

Evolution Dental Surgery and Aesthetic Centers

  • Dentist
  • Duluth, GA
National Provider Identifier
1063095842
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
EVOLUTION DENTAL SURGERY AND AESTHETIC CENTERS
Practice address
3775 Venture Dr Ste 101
Duluth, GA 30096-5102
Phone
(470) 387-0385
Fax
(678) 550-4999
NPI assigned
Apr 30, 2021
Last updated
Apr 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Authorized official

Name
Dr. Amy Camba, DMDNPI 1639480882
Title
Prosthodontist
Phone
(706) 951-3147

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

3775 Venture Dr Ste 101
Duluth, GA 30096-5102

Mailing address

3775 Venture Dr Ste 101
Duluth, GA 30096-5102
Phone (470) 387-0385

Other names 1

  • Evolution Dental Surgery Center Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address edsc@evolutiondsc.com Direct

National Provider Directory

National Provider Directory

Locations

3775 Venture Dr
Ste 101
Duluth, GA 30096
Phone (470) 387-0385

Interoperability endpoints

  • Direct secure messaging: edsc@evolutiondsc.com

Practitioners & affiliated clinicians

Practitioners 1

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": "1619740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619740800000",
    "number": "1063095842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3775 VENTURE DR STE 101",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300965102",
            "telephone_number": "470-387-0385",
            "fax_number": "678-550-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3775 VENTURE DR STE 101",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300965102",
            "telephone_number": "470-387-0385",
            "fax_number": "678-550-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLUTION DENTAL SURGERY AND AESTHETIC CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-30",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "CAMBA",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PROSTHODONTIST",
        "authorized_official_telephone_number": "706-951-3147",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "edsc@evolutiondsc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3775 Venture Dr Ste 101",
            "city": "Duluth",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300965102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Evolution Dental Surgery Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; 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.