Affordable Dentist of Snellville Ga, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

DN010714 Issued in GA

Legal business name

AFFORDABLE DENTIST OF SNELLVILLE GA, LLC

Doing business as

Snellville Family Dental

Practice address

2138 Scenic Hwy N
Ste D
Snellville, GA 30078-6106

Phone

(770) 985-2325

NPI assigned

Oct 13, 2015

Last updated

Oct 13, 2015By 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

Mr. David Vickers, DMD

Title

Owner

Phone

(912) 383-5784

Specialties & licenses 1

Addresses

Other names 1

• Snellville Family Dental Doing business as

Locations

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

{
    "created_epoch": "1444694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444694400000",
    "number": "1184095374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191363",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311191363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2138 SCENIC HWY N",
            "address_2": "STE D",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300786106",
            "telephone_number": "770-985-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFORDABLE DENTIST OF SNELLVILLE GA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-13",
        "last_updated": "2015-10-13",
        "status": "A",
        "authorized_official_last_name": "VICKERS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-383-5784",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN010714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Snellville Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Snellville, GA
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• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; 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.