NPIMap

Organization Active NPI

Georgia Dental Professionals, PC

Doing business as Elite Dentistry

  • General Practice Dentistry
  • Marietta, GA
National Provider Identifier
1104218361
Registry record updated Feb 25, 2015
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
Elite Dentistry
Practice address
3052 Shallowford Rd Ste 100
Marietta, GA 30062-1252
Phone
(770) 587-5655
NPI assigned
Feb 25, 2015
Last updated
Feb 25, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
GEORGIA DENTAL PROFESSIONALS, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 25, 2015

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

Authorized official

Name
Kim Wilson
Title
Cred Sup
Phone
(217) 540-5170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

3052 Shallowford Rd Ste 100
Marietta, GA 30062-1252

Mailing address

3052 Shallowford Rd Ste 100
Marietta, GA 30062-1252
Phone (770) 587-5655

Other names 1

  • Elite Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Georgia Dental Professionals PC72 organizations share this tax ID, including this one
Part of
Georgia Dental Professionals PC

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

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.

NPI Registry JSON

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

{
    "created_epoch": "1424822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424822400000",
    "number": "1104218361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3052 SHALLOWFORD RD STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300621252",
            "telephone_number": "770-587-5655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3052 SHALLOWFORD RD STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300621252",
            "telephone_number": "770-587-5655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DENTAL PROFESSIONALS, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA DENTAL PROFESSIONALS, PC",
        "enumeration_date": "2015-02-25",
        "last_updated": "2015-02-25",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CRED SUP",
        "authorized_official_telephone_number": "217-540-5170"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; 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.