Vineyards Dental Care

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DNO 14417 Issued in GA

Legal business name

VINEYARDS DENTAL CARE

Practice address

2095 Highway 211 NW
Suite 6-a
Braselton, GA 30517-3402

Phone

(770) 868-4288

Fax

(770) 868-4291

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Thomas J. Mazzuckelli, PHD., D.M.D.

Title

Owner

Phone

(770) 868-4288

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ilisa Beth Stern, DMD

  • General Practice Dentistry
  • Braselton, GA
  • NPI 1518001957
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225191935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2095 HIGHWAY 211 NW",
            "address_2": "SUITE 6-A",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305173402",
            "telephone_number": "770-868-4288",
            "fax_number": "770-868-4291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 HIGHWAY 211 NW",
            "address_2": "SUITE 6-A",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305173402",
            "telephone_number": "770-868-4288",
            "fax_number": "770-868-4291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINEYARDS DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAZZUCKELLI",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-868-4288",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD., D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DNO 14417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Muhammad Usman, MD
• Sreeju Vallikattil Gopi, AGACNP
• Nijja Vargas, PA
• Maria Vetrano, PA
• Victory Child & Adolescent Counseling
• Laura Jean Vogt, AGACNP
• Mariana Voronovscaia, AGACNP
• Jeremy Warren Walker, D.O.
• Lance Walker, DC
• Travelyan Marcel Walker, M.D.

• General Practice Dentistry in Braselton, GA
• Providers in Braselton, 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 Aug 22, 2020; 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.