NPIMap

Organization Active NPI

Pediatric Dental Specialist of Hiram

  • Pediatric Dentistry
  • Hiram, GA
National Provider Identifier
1245617364
Registry record updated Apr 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN013367 Issued in GA
Legal business name
PEDIATRIC DENTAL SPECIALIST OF HIRAM
Practice address
5604 Wendy Bagwell Pkwy
Suite 1100
Hiram, GA 30141-7813
Phone
(770) 943-0011
NPI assigned
Apr 27, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2015

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

Authorized official

Name
Dr. Mindy Lynn Simms, DDS
Title
President
Phone
(330) 289-6019

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X DN013367 GA Primary

Addresses

Primary practice location

5604 Wendy Bagwell Pkwy
Suite 1100
Hiram, GA 30141-7813

Mailing address

5604 Wendy Bagwell Pkwy
Suite 1100
Hiram, GA 30141-7813
Phone (770) 943-0011

National Provider Directory

National Provider Directory

Locations

5604 Wendy Bagwell Pkwy
Ste 1100
Hiram, GA 30141
Phone (770) 943-0011

NPI Registry JSON

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

{
    "created_epoch": "1430092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430092800000",
    "number": "1245617364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5604 WENDY BAGWELL PKWY",
            "address_2": "SUITE 1100",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301417813",
            "telephone_number": "770-943-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5604 WENDY BAGWELL PKWY",
            "address_2": "SUITE 1100",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301417813",
            "telephone_number": "770-943-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL SPECIALIST OF HIRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-27",
        "last_updated": "2015-04-27",
        "status": "A",
        "authorized_official_last_name": "SIMMS",
        "authorized_official_first_name": "MINDY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-289-6019",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hiram, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; 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.