NPIMap

Individual provider Active NPI

Crystal Hayes Prempeh, D.D.S, MPH

  • Pediatric Dentistry
  • Kennesaw, GA
National Provider Identifier
1124366794
Registry record updated May 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN015291 Issued in GA
Practice address
5255 Stilesboro Rd NW
Suite 110
Kennesaw, GA 30152-7737
Phone
(770) 499-2152
NPI assigned
Jan 16, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 31, 2017

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 28408 TX
Pediatric Dentistry 1223P0221X 9909 NC
Pediatric Dentistry 1223P0221X 28408 TX
Pediatric Dentistry 1223P0221X DN015291 GA Primary

Addresses

Primary practice location

5255 Stilesboro Rd NW
Suite 110
Kennesaw, GA 30152-7737

Mailing address

30 Gilmer Way
Acworth, GA 30101

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN015291GAMDPediatric Dentist
28408TXMDPediatric Dentist
9909NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hayes Prempeh Knockum and Associates Hampstead, PLLC Pediatric Dentistry Current Accepting new patients
Children'S Dentistry of West Cobb,LLC Pediatric Dentistry PastSince Aug 7, 2022 Accepting new patients
Chandler & Associates Dental Management, Inc. Pediatric Dentistry Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: cprempeh2901626@carolinashealthcaresystem.direct-ci.com

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": "1358294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496188800000",
    "number": "1124366794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 GILMER WAY",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "30101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5255 STILESBORO RD NW",
            "address_2": "SUITE 110",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301527737",
            "telephone_number": "770-499-2152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREMPEH",
        "first_name": "CRYSTAL",
        "middle_name": "HAYES",
        "name_prefix": "Dr.",
        "credential": "D.D.S, MPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-16",
        "last_updated": "2017-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "28408",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "9909",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "28408",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN015291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2017; 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.