West Georgia Dental of la Grange,PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN011455 Issued in GA

Legal business name

WEST GEORGIA DENTAL OF LA GRANGE,PC

Practice address

1555 Doctors Dr Ste 105
Lagrange, GA 30240-4132

Phone

(706) 812-8220

Fax

(706) 812-8218

NPI assigned

Jul 11, 2006

Last updated

Aug 22, 2020By 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

Dr. Tara Milligan Allen, DDS

Title

President

Phone

(706) 812-8220

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083648216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 DOCTORS DR STE 105",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404132",
            "telephone_number": "706-812-8220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 DOCTORS DR STE 105",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404132",
            "telephone_number": "706-812-8220",
            "fax_number": "706-812-8218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST GEORGIA DENTAL OF LA GRANGE,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "MILLIGAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-812-8220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN011455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS/PEACHSTATE",
            "identifier": "100198",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL/WELLCARE",
            "identifier": "167795",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Wellstreet of Georgia PC (Piedmont Urgent Care by Wellstreet)
• West Ga Oral Surgery Associates, P.C.
• West Georgia Counseling & Assessment Services
• West Georgia Counseling & Assessment Services, LLC
• West Georgia Dermatology PC
• West Georgia Family Practice P.C
• West Georgia Health Physicians Inc
• West Georgia Health Physicians Inc (West Georgia Worx)
• West Georgia Health System

• General Practice Dentistry in Lagrange, GA
• Providers in Lagrange, 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 Aug 22, 2020; 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.