Eaglin Dental Group, Johns Creek

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN013169 Issued in GA

Legal business name

EAGLIN DENTAL GROUP, JOHNS CREEK

Practice address

6290 Abbotts Bridge Rd Ste 101
Johns Creek, GA 30097-1750

Phone

(770) 418-1777

Fax

(678) 646-5982

NPI assigned

Nov 18, 2011

Last updated

Nov 18, 2011By 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

Dr. Jason S Eaglin, DDS

Title

Owner

Phone

(770) 418-1777

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1321574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321574400000",
    "number": "1245507292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6290 ABBOTTS BRIDGE RD STE 101",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971750",
            "telephone_number": "770-418-1777",
            "fax_number": "678-646-5982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6290 ABBOTTS BRIDGE RD STE 101",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971750",
            "telephone_number": "770-418-1777",
            "fax_number": "678-646-5982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLIN DENTAL GROUP, JOHNS CREEK",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-18",
        "last_updated": "2011-11-18",
        "status": "A",
        "authorized_official_last_name": "EAGLIN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-418-1777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013169",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013169",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "777472578D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; 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.