Lakeside Pediatric Dentistry, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN012737 Issued in GA

Legal business name

LAKESIDE PEDIATRIC DENTISTRY, LLC

Practice address

1050 Parkside CMNS
Suite 103
Greensboro, GA 30642-4524

Phone

(706) 454-2222

Fax

(706) 454-1234

NPI assigned

Mar 17, 2017

Organization subpart

No

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

Authorized official

Name

Tina Locher

Title

Office Manager

Phone

(478) 743-0901

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1489708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489708800000",
    "number": "1174064539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 PARKSIDE CMNS",
            "address_2": "SUITE 103",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306424524",
            "telephone_number": "706-454-2222",
            "fax_number": "706-454-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 PARKSIDE CMNS",
            "address_2": "SUITE 103",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306424524",
            "telephone_number": "706-454-2222",
            "fax_number": "706-454-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-17",
        "last_updated": "2017-03-17",
        "status": "A",
        "authorized_official_last_name": "LOCHER",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "478-743-0901"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN012737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2017; 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.