SM Dentistry Inc

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SM DENTISTRY INC

Practice address

2415 W Park Place Blvd
Stone Mountain, GA 30087-3566

Phone

(770) 879-1200

Fax

(770) 413-1821

NPI assigned

Sep 9, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Chin S Park, DMDNPI 1508139890

Title

Dentist

Phone

(770) 879-1200

Specialties & licenses 1

Addresses

Other names 1

• Park Family Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chin S Park, DMD

  • General Practice Dentistry
  • Stone Mountain, GA
  • NPI 1508139890
  NPD Authorized official
• Karl Burgess, DDS

  • Dentist
  • Stone Mountain, GA
  • NPI 1962516161
  NPD (past)

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

{
    "created_epoch": "1725840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725840000000",
    "number": "1124854096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 W PARK PLACE BLVD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873566",
            "telephone_number": "770-879-1200",
            "fax_number": "770-413-1821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 W PARK PLACE BLVD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873566",
            "telephone_number": "770-879-1200",
            "fax_number": "770-413-1821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SM DENTISTRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-09",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "CHIN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "770-879-1200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Robert Daniel Slade, PHARM D
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• Dentist in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; 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.