Mahant Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MAHANT DENTAL LLC

Doing business as

Perry Family Dentist

Practice address

5396 Floyd Rd SW
Mableton, GA 30126-2216

Phone

(770) 941-7588

Fax

(770) 941-2119

NPI assigned

Nov 2, 2021

Organization subpart

Yes

Parent organization

MAHANT DENTAL LLCAs reported in NPPES

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

Authorized official

Name

Kelley Halvorsen

Title

Insurance Administrator

Phone

(727) 686-3773

Specialties & licenses 1

Addresses

Other names 1

• Perry Family Dentist Doing business as

Part of

Mahant Dental LLC

Locations

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1205591526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 CROMWELL DR APT SUITE",
            "city": "TARPON SPRINGS",
            "state": "FL",
            "postal_code": "346893017",
            "telephone_number": "727-686-3773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5396 FLOYD RD SW",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301262216",
            "telephone_number": "770-941-7588",
            "fax_number": "770-941-2119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHANT DENTAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAHANT DENTAL LLC",
        "enumeration_date": "2021-11-02",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A",
        "authorized_official_last_name": "HALVORSEN",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "INSURANCE ADMINISTRATOR",
        "authorized_official_telephone_number": "727-686-3773"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Perry Family Dentist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Bianca Sherise Marshall
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• Lashawn Marie McKenzie, MSW
• McPerry LLC

• General Practice Dentistry in Mableton, GA
• Providers in Mableton, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.