Executive Park Dentistry, P.C.

Primary specialty

DentistTaxonomy code 122300000X

License

DN012967 Issued in GA

Legal business name

EXECUTIVE PARK DENTISTRY, P.C.

Practice address

17 Executive Park Dr NE
Suite 100
Atlanta, GA 30329-2251

Phone

(404) 633-0715

NPI assigned

Jul 16, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Omar S DamjiNPI 1760692321

Title

Owner/Dentist

Phone

(404) 664-6876

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Omar Shiraz Damji, DMD

  • General Practice Dentistry
  • Lawrenceville, GA
  • NPI 1760692321
  NPD (past) Authorized official

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342396800000",
    "number": "1124373139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 EXECUTIVE PARK DR NE",
            "address_2": "SUITE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 EXECUTIVE PARK DR NE",
            "address_2": "SUITE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292251",
            "telephone_number": "404-633-0715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE PARK DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-16",
        "last_updated": "2012-07-16",
        "status": "A",
        "authorized_official_last_name": "DAMJI",
        "authorized_official_first_name": "OMAR",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "404-664-6876",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN012967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; 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.