Mustard Seed Pediatric Dentistry, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN013415 Issued in GA

Legal business name

MUSTARD SEED PEDIATRIC DENTISTRY, LLC

Practice address

1120 Peachtree Industrial Blvd
Suite 203 and 204
Suwanee, GA 30024-2013

Phone

(770) 904-7005

Fax

(770) 904-7075

NPI assigned

Sep 15, 2009

Organization subpart

No

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

Authorized official

Name

Yoo Mee Kim, DDS

Title

Dentist/Owner

Phone

(770) 904-7005

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Wan Kim

  • Dental Assistant
  • Suwanee, GA
  • NPI 1285925669
  NPD (past)
• Turkessa Lashelle Williams

  • Dental Assistant
  • Suwanee, GA
  • NPI 1659662039
  NPD (past)

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

{
    "created_epoch": "1252972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252972800000",
    "number": "1093048563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 203 AND 204",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242013",
            "telephone_number": "770-904-7005",
            "fax_number": "770-904-7075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 203 AND 204",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242013",
            "telephone_number": "770-904-7005",
            "fax_number": "770-904-7075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUSTARD SEED PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-15",
        "last_updated": "2009-09-15",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "YOO MEE",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "770-904-7005",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI #",
            "identifier": "1255479689",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittany Caroline Murrow, ACNPC-AG
• Darra Murti, PT
• Preethi Murugappan, FNP
• Musely Compounding Pharmacy East LLC
• Sundas Mushtaq
• Usha Musunuru, MD
• Adriana Muzquiz
• Kaylyn Myers, RBT
• Myeyedr Optometry of Georgia, LLC
• Robert S. NA, LDO

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; 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.