Wonderland Pediatric Dentistry, PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN 014759 Issued in GA

Legal business name

WONDERLAND PEDIATRIC DENTISTRY, PC

Practice address

1570 Old Alabama Rd Ste 104
Roswell, GA 30076-2108

Phone

(678) 878-3711

Fax

(678) 878-3714

NPI assigned

Sep 23, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Karina Bogdasarova, DDS

Title

Owner

Phone

(720) 404-8805

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1411430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411430400000",
    "number": "1134521990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 OLD ALABAMA RD STE 104",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300762108",
            "telephone_number": "678-878-3711",
            "fax_number": "678-878-3714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 OLD ALABAMA RD STE 104",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300762108",
            "telephone_number": "678-878-3711",
            "fax_number": "678-878-3714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WONDERLAND PEDIATRIC DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-23",
        "last_updated": "2014-09-23",
        "status": "A",
        "authorized_official_last_name": "BOGDASAROVA",
        "authorized_official_first_name": "KARINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-404-8805",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN 014759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003146415",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tessa Trussell Wolf, PSYD
• Casey A Wolfe, DPT
• Nancy E Wolff, MS,PT
• Wendy L Wolff, GNP-C
• Wonderland Pediatric Dentistry
• Wonderlove Lactation Services
• Alexander Wood
• Jody L. Wood, LCSW
• Shannon Wood, PHYSICAL THERAPIST
• Sheila Woodall, MS

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; 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.