NPIMap

Organization Active NPI

Peach Blossom Dental, LLC

  • Dental Clinic/Center
  • Tucker, GA
National Provider Identifier
1174051908
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PEACH BLOSSOM DENTAL, LLC
Practice address
2256 Northlake Pkwy Ste 150
Tucker, GA 30084-4004
Phone
(770) 934-5144
Fax
(678) 273-3634
NPI assigned
May 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Angela Dawn Wright, DDSNPI 1669554374
Title
Owner
Phone
(770) 934-5144

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

2256 Northlake Pkwy Ste 150
Tucker, GA 30084-4004

Mailing address

2256 Northlake Pkwy Ste 150
Tucker, GA 30084-4004
Phone (770) 934-5144

National Provider Directory

National Provider Directory

Locations

2256 Northlake Pkwy
Ste 150
Tucker, GA 30084
Phone (770) 934-5144

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1174051908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2256 NORTHLAKE PKWY STE 150",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844004",
            "telephone_number": "770-934-5144",
            "fax_number": "678-273-3634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2256 NORTHLAKE PKWY STE 150",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844004",
            "telephone_number": "770-934-5144",
            "fax_number": "678-273-3634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH BLOSSOM DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-934-5144",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.