Individual provider Active NPI

Brandon Lee Esco, DMD

  • Dentist
  • Snellville, GA
National Provider Identifier
1164724464
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN014069 Issued in GA
Practice address
1569 Janmar Rd Ste a
Snellville, GA 30078-5780
Phone
(770) 979-7923
Fax
(678) 990-6954
NPI assigned
Nov 19, 2010
Last updated
Jun 20, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN014069 GA Primary

Addresses

Primary practice location

1569 Janmar Rd Ste a
Snellville, GA 30078-5780

Mailing address

1569 Janmar Rd Ste a
Snellville, GA 30078-5780
Phone (770) 979-7923

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150710000261 GA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9133431703

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN014069GAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Sleep Elite LLC CurrentSince Jun 4, 2023 Accepting new patients
Sleep Elite LLC CurrentSince Jul 7, 2020 Accepting new patients
Brookwood Dentistry, LLC General Practice CurrentSince Jul 7, 2024 Accepting new patients
Professional Dental Alliance of Athens, LLC Dentist Past Accepting new patients
Advanced Athens Dentistry, PC Past Accepting new patients

Locations

1569 Janmar Rd
Ste A
Snellville, GA 30078
Phone (770) 979-7923

1569 Janmar Rd
Ste E
Snellville, GA 30078
Phone (770) 979-7923

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1290124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1164724464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1569 JANMAR RD STE A",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300785780",
            "telephone_number": "770-979-7923",
            "fax_number": "678-990-6954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1569 JANMAR RD STE A",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300785780",
            "telephone_number": "770-979-7923",
            "fax_number": "678-990-6954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESCO",
        "first_name": "BRANDON",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-19",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN014069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

Verify at the official NPI Registry.