Enw Dentistry PC Dba

Primary specialty

DentistTaxonomy code 122300000X

License

009491 Issued in GA

Legal business name

ENW DENTISTRY PC DBA

Practice address

4574 Lawrenceville Hwy NW
120
Lilburn, GA 30047-3618

Phone

(770) 921-9000

Fax

(770) 931-7704

NPI assigned

Sep 13, 2006

Organization subpart

No

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

Authorized official

Name

Ginger Gardner

Title

Manager

Phone

(770) 231-7657

Specialties & licenses 1

Addresses

Other names 1

• Zoom Dental Doing business as

Tax ID family

Enw Dentistry PC Dba2 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.

• Enw Dentistry PC Dba

  • General Practice Dentistry
  • Riverdale, GA
  • NPI 1134223696
  NPD tax ID

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083719439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4574 LAWRENCEVILLE HWY",
            "address_2": "120",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473618",
            "telephone_number": "770-921-9000",
            "fax_number": "770-931-7704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4574 LAWRENCEVILLE HWY NW",
            "address_2": "120",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473618",
            "telephone_number": "770-921-9000",
            "fax_number": "770-931-7704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENW DENTISTRY PC DBA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GINGER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-231-7657"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "009491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Zoom Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Dentist 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.