Jennifer Canada McKnight, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN123035 Issued in GA

Practice address

3387 Highway 5
Douglasville, GA 30135-6900

Phone

(678) 813-2388

NPI assigned

Jul 8, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Jennifer Canada Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Douglasville Dentistry for Kids

  • Pediatric Dentistry
  • Douglasville, GA
  • NPI 1881006427
  NPD (past)

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

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1124401146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6725 N. 35TH AVE., #105",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85017",
            "telephone_number": "602-595-5230",
            "fax_number": "602-595-5280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3387 HIGHWAY 5",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301356900",
            "telephone_number": "678-813-2388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6725 N 35th Ave # 105",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850171083",
            "country_code": "US",
            "telephone_number": "602-595-5230",
            "fax_number": "602-595-5280",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Brookdale Plz",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112123139",
            "country_code": "US",
            "telephone_number": "718-240-5021",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2880 Johnson Ferry Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300628368",
            "country_code": "US",
            "telephone_number": "678-813-2388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANADA MCKNIGHT",
        "first_name": "JENNIFER",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-08",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "9796",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN123035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "CANADA",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tapaynga Alise Calloway
• Shenelle Camacho, RBT
• Heather Robinson Camp, D.C.
• Cori Campbell, BCBA
• Katherine L Campbell, CSA
• Chris Cancino
• Brett H Cannon, MD
• Cassandra Lichkay Cannon, DMD
• Capri Medical Center
• Care From the Heart Private Home Care LLC

• Pediatric Dentistry in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; 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.