NPIMap

Organization Active NPI

Northeast Georgia Dental Group

Doing business as BGW Dental Group

  • General Practice Dentistry
  • Braselton, GA
National Provider Identifier
1063904076
Registry record updated Jun 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
NORTHEAST GEORGIA DENTAL GROUP
Doing business as
BGW Dental Group
Practice address
1205 Friendship Road
Braselton, GA 30517
Phone
(770) 532-4555
Fax
(770) 536-8053
NPI assigned
Jun 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2018

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

Authorized official

Name
Ann Sorensen
Title
Director of Operations
Phone
(770) 532-4555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1205 Friendship Road
Braselton, GA 30517

Mailing address

1215 Vine St NE
Gainesville, GA 30501-2535
Phone (770) 532-4555

Other names 1

  • BGW Dental Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
BGW Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1205 Friendship Rd
Braselton, GA 30517
Phone (470) 348-2466

1215 Vine St NE
Gainesville, GA 30501
Phone (770) 532-4555

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528156800000",
    "number": "1063904076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 VINE ST NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012535",
            "telephone_number": "770-532-4555",
            "fax_number": "770-536-8053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 FRIENDSHIP ROAD",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "30517",
            "telephone_number": "770-532-4555",
            "fax_number": "770-536-8053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-05",
        "last_updated": "2018-06-05",
        "status": "A",
        "authorized_official_last_name": "SORENSEN",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "770-532-4555"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BGW Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BGW Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Braselton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; 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.