NPIMap

Organization Active NPI

Supreme Dental Group LLC

  • Dentist
  • Suwanee, GA
National Provider Identifier
1093414146
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SUPREME DENTAL GROUP LLC
Practice address
3855 Johns Creek Pkwy Ste a
Suwanee, GA 30024-1293
Phone
(770) 744-3855
NPI assigned
Feb 27, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Authorized official

Name
Xiaodan ZhangNPI 1578129573
Title
Dentist
Phone
(770) 744-3855

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

3855 Johns Creek Pkwy Ste a
Suwanee, GA 30024-1293

Mailing address

3855 Johns Creek Pkwy Ste a
Suwanee, GA 30024-1293
Phone (770) 744-3855

National Provider Directory

National Provider Directory

Locations

3855 Johns Creek Pkwy
Ste A
Suwanee, GA 30024
Phone (507) 319-2391

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1677456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1093414146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3855 JOHNS CREEK PKWY STE A",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300241293",
            "telephone_number": "770-744-3855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3855 JOHNS CREEK PKWY STE A",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300241293",
            "telephone_number": "770-744-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-27",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A",
        "authorized_official_last_name": "ZHANG",
        "authorized_official_first_name": "XIAODAN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "770-744-3855"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Oct 31, 2023; 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.