Dentistry for Children of Jonesboro, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

DENTISTRY FOR CHILDREN OF JONESBORO, LLC

Practice address

435 Arrowhead Blvd
Jonesboro, GA 30236-1219

Phone

(770) 478-8400

Fax

(770) 473-8766

NPI assigned

Nov 10, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Charles Coulter

Title

Pediatric Dentist

Phone

(770) 473-1350

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Brad Warren Roehl, DMD

  • Pediatric Dentistry
  • Jonesboro, GA
  • NPI 1902829161
  NPD (past)

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

{
    "created_epoch": "1289347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289347200000",
    "number": "1083915896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 COUNTRY CLUB DR",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817350",
            "telephone_number": "770-473-1350",
            "fax_number": "770-692-0098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 ARROWHEAD BLVD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361219",
            "telephone_number": "770-478-8400",
            "fax_number": "770-473-8766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTISTRY FOR CHILDREN OF JONESBORO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-10",
        "last_updated": "2010-11-10",
        "status": "A",
        "authorized_official_last_name": "COULTER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "770-473-1350",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delta & Charley 3208 LLC
• Samantha Denegri, BCBA-D, LBA
• Kendall Denose
• Dentfirst PC
• Dentistry for Children
• Niyati Desai, DPT
• Emily King Deschler, M.D.
• Ingrid Israell Desir-Joseph, M.D.
• Destiny Bound Management
• Yolanda Devereaux, CNM

• Pediatric Dentistry in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; 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.