NPIMap

Individual provider Active NPI

Syretta Wells, DDS

  • Prosthodontics
  • Forest Park, GA
National Provider Identifier
1184875882
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
DN13505 Issued in GA
Practice address
4930 Governors Dr
Suite 405
Forest Park, GA 30297-6101
Phone
(404) 363-1700
Fax
(404) 363-0700
NPI assigned
Oct 1, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN13505 GA
Prosthodontics 1223P0700X DN13505 GA Primary

Addresses

Primary practice location

4930 Governors Dr
Suite 405
Forest Park, GA 30297-6101

Mailing address

4930 Governors Dr
Suite 405
Forest Park, GA 30297-6101
Phone (404) 363-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN13505GAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Mouthpeace Dental 5 LLC Current Accepting new patients
Mouthpeace Dental 4, LLC Current Accepting new patients
Forest Parkway Dental Group General Practice Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222819200000",
    "number": "1184875882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 GOVERNORS DR",
            "address_2": "SUITE 405",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302976101",
            "telephone_number": "404-363-1700",
            "fax_number": "404-363-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 GOVERNORS DR",
            "address_2": "SUITE 405",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302976101",
            "telephone_number": "404-363-1700",
            "fax_number": "404-363-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLS",
        "first_name": "SYRETTA",
        "name_prefix": "Ms.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-01",
        "last_updated": "2008-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN13505",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "GA",
            "license": "DN13505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Park, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; 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.