NPIMap

Organization Active NPI

Dental Center of Vidalia

  • General Practice Dentistry
  • Vidalia, GA
National Provider Identifier
1104044056
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL CENTER OF VIDALIA
Practice address
1209 East First Street
Vidalia, GA 30474
Phone
(912) 537-7048
NPI assigned
Apr 23, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Angie J. Waller
Title
Financial Coordinator
Phone
(912) 537-7048

Practitioners 3

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

National Provider Directory

National Provider Directory

Locations

1209 E 1st St
Vidalia, GA 30474
Phone (912) 537-6088

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

NPPES NPI Registry

Primary practice location

1209 East First Street
Vidalia, GA 30474

Mailing address

P.O. Box 524
Vidalia, GA 30475
Phone (912) 537-7048

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104044056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 524",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "30475",
            "telephone_number": "912-537-7048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 EAST FIRST STREET",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "30474",
            "telephone_number": "912-537-7048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL CENTER OF VIDALIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "FINANCIAL COORDINATOR",
        "authorized_official_telephone_number": "912-537-7048"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vidalia, GA

Sources for this page

  • 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.