Surfside Kids Pediatric Dentistry P.C.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DN015083 Issued in GA

Legal business name

SURFSIDE KIDS PEDIATRIC DENTISTRY P.C.

Practice address

256 Scranton Connector
Ste 110
Brunswick, GA 31525-0556

Phone

(912) 272-7656

NPI assigned

May 11, 2016

Last updated

May 11, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Loy Hagan, DDSNPI 1063745479

Title

Pediatric Dentist

Phone

(912) 272-7656

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.

• Loy Adam Hagan, DDS

  • Pediatric Dentistry
  • Savannah, GA
  • NPI 1063745479
  Authorized official Same address or phone

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

{
    "created_epoch": "1462924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462924800000",
    "number": "1144676826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 SCRANTON CONNECTOR",
            "address_2": "STE 110",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315250556",
            "telephone_number": "912-272-7656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 SCRANTON CONNECTOR",
            "address_2": "STE 110",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315250556",
            "telephone_number": "912-272-7656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURFSIDE KIDS PEDIATRIC DENTISTRY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-11",
        "last_updated": "2016-05-11",
        "status": "A",
        "authorized_official_last_name": "HAGAN",
        "authorized_official_first_name": "LOY",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "912-272-7656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "DN015083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janna Marie Summerall-Smith, M.D.
• Summit Dermatology & Laser Center, P.C.
• Summit Internal Medicine (Glynn Medical Associates)
• Summit Plastic Surgery
• Surf and Sand Pediatrics
• Ralph Wade Swann Jr., MD
• Montana Swanson, DPT
• Patience Tajelleh
• Tamsyn O'Flynn, Aprn
• Olga Fundyler Tate, M.D.

• Dental Clinic/Center in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2016; 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.