NPIMap

Organization Active NPI

Fayetteville Pediatric Dentistry

  • Pediatric Dentistry
  • Fayetteville, GA
National Provider Identifier
1073056933
Registry record updated Nov 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN013057 Issued in GA
Legal business name
FAYETTEVILLE PEDIATRIC DENTISTRY
Practice address
320 N Jeff Davis Dr
Suite C
Fayetteville, GA 30214-1669
Phone
(770) 651-1000
NPI assigned
Nov 28, 2016
Last updated
Nov 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2016

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

Authorized official

Name
Dr. Vishant Nath, DMD
Title
Dentist
Phone
(770) 651-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DN013057 GA Primary

Addresses

Primary practice location

320 N Jeff Davis Dr
Suite C
Fayetteville, GA 30214-1669

Mailing address

320 N Jeff Davis Dr
Suite C
Fayetteville, GA 30214-1669
Phone (770) 651-1000

National Provider Directory

National Provider Directory
Tax ID family
Norcross Pediatric Dentistry4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

320 N Jeff Davis Dr
Ste C
Fayetteville, GA 30214
Phone (770) 460-6000

NPI Registry JSON

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480291200000",
    "number": "1073056933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 N JEFF DAVIS DR",
            "address_2": "SUITE C",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141669",
            "telephone_number": "770-651-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N JEFF DAVIS DR",
            "address_2": "SUITE C",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141669",
            "telephone_number": "770-651-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-28",
        "last_updated": "2016-11-28",
        "status": "A",
        "authorized_official_last_name": "NATH",
        "authorized_official_first_name": "VISHANT",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "770-651-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.

Verify at the official NPI Registry.