MC Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MC DENTAL LLC

Practice address

3615 Charles Hardy Pkwy Ste 200
Dallas, GA 30157-9472

Phone

(770) 767-5546

Fax

(770) 505-5206

NPI assigned

Jun 4, 2019

Last updated

Dec 7, 2021By 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

Theresa Chung

Title

President- Walmart Health Dental

Phone

(707) 675-5546

Specialties & licenses 1

Addresses

Tax ID family

MC Dental LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• MC Dental LLC

  • Dentist
  • Calhoun, GA
  • NPI 1447892377
  NPD tax ID

Locations

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

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1174181119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727160445",
            "telephone_number": "479-204-1258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 CHARLES HARDY PKWY STE 200",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301579472",
            "telephone_number": "770-767-5546",
            "fax_number": "770-505-5206"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2042 W Spring St",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "GA",
            "postal_code": "306553164",
            "country_code": "US",
            "telephone_number": "770-266-5676",
            "fax_number": "770-266-5985",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3245 Lawrenceville Suwanee Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Suwanee",
            "state": "GA",
            "postal_code": "300246541",
            "country_code": "US",
            "telephone_number": "678-546-8649",
            "fax_number": "678-546-8615",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6435 Bells Ferry Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "GA",
            "postal_code": "301892317",
            "country_code": "US",
            "telephone_number": "770-928-0682",
            "fax_number": "770-928-0646",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1438 Dogwood Dr. SE",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "30013",
            "country_code": "US",
            "telephone_number": "770-602-4183",
            "fax_number": "833-314-0488",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "137 Willow Ln",
            "address_purpose": "LOCATION",
            "city": "McDonough",
            "state": "GA",
            "postal_code": "302536574",
            "country_code": "US",
            "telephone_number": "470-483-0413",
            "fax_number": "770-954-0647",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "125 Pavilion Pkwy Ste A",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "GA",
            "postal_code": "302144098",
            "country_code": "US",
            "telephone_number": "770-719-0932",
            "fax_number": "770-719-0940",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4221 Atlanta Hwy Ste 101",
            "address_purpose": "LOCATION",
            "city": "Loganville",
            "state": "GA",
            "postal_code": "300527316",
            "country_code": "US",
            "telephone_number": "770-554-1167",
            "fax_number": "770-554-1185",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "210 Cobb Pkwy S Ste 100",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300606509",
            "country_code": "US",
            "telephone_number": "770-427-9151",
            "fax_number": "770-427-9154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MC DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-04",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A",
        "authorized_official_last_name": "CHUNG",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "PRESIDENT- WALMART HEALTH DENTAL",
        "authorized_official_telephone_number": "707-675-5546"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Mason, SLP
• Rose Katie Massenat
• McKenzie Marie Mathison, PHARMD
• Maurina Private Homecare LLC
• Sabelle Mbye, NP
• MC DO Optometry LLC
• MC Medical LLC (Walmart Health)
• MC Medical LLC
• Tammie Small McCallie, DC
• Samuel Kevin McClendon, RPH

• Dentist in Dallas, GA
• Providers in Dallas, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; 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.