Mini Smiles Pediatric Dentistry, PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN013140 Issued in GA

Legal business name

MINI SMILES PEDIATRIC DENTISTRY, PC

Practice address

1400 Dogwood Dr SE
Conyers, GA 30013-5037

Phone

(770) 761-5690

Fax

(770) 761-9750

NPI assigned

Sep 10, 2013

Organization subpart

No

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

Authorized official

Name

Keysra M Washington, DDS

Title

Owner/Dentist

Phone

(770) 761-5690

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1378771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391731200000",
    "number": "1184059073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 DOGWOOD DR SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300135037",
            "telephone_number": "770-761-5690",
            "fax_number": "770-761-9750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 DOGWOOD DR SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300135037",
            "telephone_number": "770-761-5690",
            "fax_number": "770-761-9750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINI SMILES PEDIATRIC DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-10",
        "last_updated": "2014-02-07",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "KEYSRA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "770-761-5690",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1376603308",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2014; 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.