NPIMap

Organization Active NPI

Georgia Dental Professionals, PC

Doing business as Suwanee Dental Care

  • General Practice Dentistry
  • Suwanee, GA
National Provider Identifier
1083978555
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Doing business as
Suwanee Dental Care
Practice address
4355 Suwanee Dam Rd
Suwanee, GA 30024-6707
Phone
(770) 614-7300
Fax
(770) 614-7911
NPI assigned
Jun 29, 2012
Last updated
Nov 7, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
GEORGIA DENTAL PROFESSIONALS, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

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

Authorized official

Name
Kendra Walker
Title
Credentialing Team Lead
Phone
(217) 540-8312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

4355 Suwanee Dam Rd
Suwanee, GA 30024-6707

Mailing address

4355 Suwanee Dam Rd
Suwanee, GA 30024-6707
Phone (770) 614-7300

Other names 1

  • Suwanee Dental Care Doing business as

National Provider Directory

National Provider Directory
Part of
Georgia Dental Professionals PC

Locations

4355 Suwanee Dam Rd
Suwanee, GA 30024
Phone (770) 614-7300

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1083978555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4355 SUWANEE DAM RD",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246707",
            "telephone_number": "770-614-7300",
            "fax_number": "770-614-7911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4355 SUWANEE DAM RD",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246707",
            "telephone_number": "770-614-7300",
            "fax_number": "770-614-7911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DENTAL PROFESSIONALS, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA DENTAL PROFESSIONALS, PC",
        "enumeration_date": "2012-06-29",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8312"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suwanee Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Suwanee, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.