NPIMap

Organization Active NPI

North Georgia Dental Sedation Center

  • Pediatric Dentistry
  • Gainesville, GA
National Provider Identifier
1194972901
Registry record updated Aug 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN012082 Issued in GA
Legal business name
NORTH GEORGIA DENTAL SEDATION CENTER
Practice address
655 Jesse Jewel Pkwy SE
Suite E
Gainesville, GA 30501
Phone
(770) 539-9110
Fax
(678) 714-8388
NPI assigned
Aug 22, 2008
Organization subpart
Yes
Parent organization
CHILDRENS DENTISTRY AT GAINESVILLEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 22, 2008

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

Authorized official

Name
Mariella Ramos
Title
Office Manager
Phone
(678) 714-7011

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X DN012082 GA Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X DN013443 GA
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X DN008032 GA

Addresses

Primary practice location

655 Jesse Jewel Pkwy SE
Suite E
Gainesville, GA 30501

Mailing address

655 Jesse Jewell Pkwy SE
Suite
Gainesville, GA 30501-3756
Phone (770) 539-9110

Other identifiers 3

IdentifierTypeStateIssuer
000046582YMedicaidGA
500132139CMedicaidGA
000851727BMedicaidGA

National Provider Directory

National Provider Directory
Part of
Children'S Dentistry at Hamilton Mill

Locations

655 Jesse Jewell Pkwy SE
Ste E
Gainesville, GA 30501
Phone (678) 714-7011

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": "1219363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219363200000",
    "number": "1194972901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 JESSE JEWELL PKWY SE",
            "address_2": "SUITE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013756",
            "telephone_number": "770-539-9110",
            "fax_number": "678-714-8388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 JESSE JEWEL PKWY SE",
            "address_2": "SUITE E",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "770-539-9110",
            "fax_number": "678-714-8388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH GEORGIA DENTAL SEDATION CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDRENS DENTISTRY AT GAINESVILLE",
        "enumeration_date": "2008-08-22",
        "last_updated": "2008-08-22",
        "status": "A",
        "authorized_official_last_name": "RAMOS",
        "authorized_official_first_name": "MARIELLA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "678-714-7011"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN012082",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013443",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN008032",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000046582Y",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500132139C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000851727B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.