NPIMap

Organization Active NPI

Mouthpeace Dental 2, PC

  • Dentist
  • Atlanta, GA
National Provider Identifier
1124552203
Registry record updated Apr 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN013505 Issued in GA
Legal business name
MOUTHPEACE DENTAL 2, PC
Practice address
1833 Delowe Dr SW
Building a
Atlanta, GA 30311-4701
Phone
(404) 793-2570
Fax
(404) 793-2577
NPI assigned
Apr 17, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2017

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

Authorized official

Name
Syretta Wells, DDS
Title
Owner
Phone
(404) 793-2570

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN013505 GA Primary

Addresses

Primary practice location

1833 Delowe Dr SW
Building a
Atlanta, GA 30311-4701

Mailing address

1833 Delowe Dr SW
Building a
Atlanta, GA 30311-4701
Phone (404) 793-2570

Other identifiers 1

IdentifierTypeStateIssuer
003180368AMedicaidGA

National Provider Directory

National Provider Directory

Locations

1833 Delowe Dr SW
Bldg A
Atlanta, GA 30311
Phone (404) 793-2570

NPI Registry JSON

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

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492387200000",
    "number": "1124552203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 DELOWE DR SW",
            "address_2": "BUILDING A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303114701",
            "telephone_number": "404-793-2570",
            "fax_number": "404-793-2577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1833 DELOWE DR SW",
            "address_2": "BUILDING A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303114701",
            "telephone_number": "404-793-2570",
            "fax_number": "404-793-2577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUTHPEACE DENTAL 2, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-17",
        "last_updated": "2017-04-17",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "SYRETTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-793-2570",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN013505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003180368A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 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.