NPIMap

Organization Active NPI

Young Smiles Dentistry for Kids

  • Pediatric Dentistry
  • Powder Springs, GA
National Provider Identifier
1174832802
Registry record updated Sep 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
YOUNG SMILES DENTISTRY FOR KIDS
Practice address
4150 Macland Rd
Suite 205
Powder Springs, GA 30127-1202
Phone
(770) 222-1344
NPI assigned
Sep 29, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2010

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

Authorized official

Name
Dr. Kevin R Jackson, DDSNPI 1265570683
Title
Dentist
Phone
(770) 222-1344

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

4150 Macland Rd
Suite 205
Powder Springs, GA 30127-1202

Mailing address

4150 Macland Rd
Suite 205
Powder Springs, GA 30127-1202
Phone (770) 222-1344

National Provider Directory

National Provider Directory

Locations

4150 Macland Rd
Ste 205
Powder Springs, GA 30127
Phone (770) 222-1344

Practitioners & affiliated clinicians

Practitioners 4

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": "1285718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285718400000",
    "number": "1174832802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 MACLAND RD",
            "address_2": "SUITE 205",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301271202",
            "telephone_number": "770-222-1344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 MACLAND RD",
            "address_2": "SUITE 205",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301271202",
            "telephone_number": "770-222-1344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUNG SMILES DENTISTRY FOR KIDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-29",
        "last_updated": "2010-09-29",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "770-222-1344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Powder Springs, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2010; 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.