Individual provider Active NPI

Amar Mistry, DDS

  • General Practice Dentistry
  • Dunwoody, GA
National Provider Identifier
1104274976
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN122972 Issued in GA
Practice address
2472 Jett Ferry Rd Ste 430
Dunwoody, GA 30338-3059
Phone
(770) 396-8061
NPI assigned
Jun 2, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30.025024 OH
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X DN122972 GA Primary

Addresses

Primary practice location

2472 Jett Ferry Rd Ste 430
Dunwoody, GA 30338-3059

Mailing address

6403 Country Ridge Dr
Troy, MI 48098-6549

Other practice location 1

640 Brighton Ave
#1
Portland, ME 04102
Phone (207) 874-1028

Other practice location 2

9000 N Main St Ste 207
Englewood, OH 45415-1165
Phone (937) 836-7282

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN122972GAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Vernon Dental Group, LLC CurrentSince Jan 5, 2025 Accepting new patients
Thomas K Sparkman, DDS, PC PastSince Jan 5, 2025 Accepting new patients
Pfdental Reddy Inc General Practice Past Accepting new patients

Locations

2472 Jett Ferry Rd
Ste 430
Dunwoody, GA 30338
Phone (770) 396-8061

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1104274976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6403 COUNTRY RIDGE DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480986549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2472 JETT FERRY RD STE 430",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "303383059",
            "telephone_number": "770-396-8061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Brighton Ave",
            "address_2": "#1",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "04102",
            "country_code": "US",
            "telephone_number": "207-874-1028",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9000 N Main St Ste 207",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "OH",
            "postal_code": "454151165",
            "country_code": "US",
            "telephone_number": "937-836-7282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MISTRY",
        "first_name": "AMAR",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-02",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.025024",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN122972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunwoody, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2025; 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.