Eisenhower Parkway Dental Group, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015152 Issued in GA

Legal business name

EISENHOWER PARKWAY DENTAL GROUP, LLC

Doing business as

Youth Dentistry of Macon

Practice address

1536 Eisenhower Pkwy
Macon, GA 31206

Phone

(478) 781-4333

Fax

(478) 781-4331

NPI assigned

Oct 12, 2016

Last updated

Jul 5, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Linda Susan Zoeller

Title

Authorized Official

Phone

(615) 988-2627

Specialties & licenses 1

Addresses

Other names 1

• Youth Dentistry of Macon Doing business as

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530748800000",
    "number": "1073063228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 CHURCH ST STE 2210",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372192204",
            "telephone_number": "615-988-2627",
            "fax_number": "631-857-7860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1536 EISENHOWER PKWY",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31206",
            "telephone_number": "478-781-4333",
            "fax_number": "478-781-4331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EISENHOWER PARKWAY DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2018-07-05",
        "status": "A",
        "authorized_official_last_name": "ZOELLER",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-988-2627"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Youth Dentistry of Macon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Youth Dentistry of Macon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Adam Jay Ehalt, PHARM.D., MS
• Ehi Pharmacy Solutions, LLC.
• Elizabeth Eidson
• Caitlin Elizabeth Eilers, PA-C
• Gregory Eilers, MD
• Richard Eisner, M.D.
• Chibuzor Chika Ejike, MD
• Brown Nnamdi Ekeledo, MD
• Chidi William Ekeledo, DO
• Sydney Barnes Ekeledo, MD

• General Practice Dentistry in Macon, GA
• Providers in Macon, 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 Jul 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.