Southern Smiles Dentistry Cumming PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SOUTHERN SMILES DENTISTRY CUMMING PC

Doing business as

Sharon Springs Dental

Practice address

1475 Peachtree Pkwy Ste C3
Cumming, GA 30041-9793

Phone

(470) 253-1747

NPI assigned

Jun 28, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Samuel Richter, RDH

Title

Office Manager

Phone

(470) 253-1747

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sharon Springs Dental Doing business as

Locations

Practitioners 1

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

• Iryna Korniyenko Yelisetty, D.M.D, M.S.D.

  • Endodontics
  • Lutz, FL
  • NPI 1225310592
  NPD (past)

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624838400000",
    "number": "1265002703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1475 PEACHTREE PKWY STE C3",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300419793",
            "telephone_number": "470-253-1747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 PEACHTREE PKWY STE C3",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300419793",
            "telephone_number": "470-253-1747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SMILES DENTISTRY CUMMING PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A",
        "authorized_official_last_name": "RICHTER",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "470-253-1747",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPO",
            "identifier": "1225310592",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sharon Springs Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Geetha Reddy Soodini, MD
• Barbara Ellen Vicar Sortor, PT
• Gabriel Sousa Lima
• Southeastern Dermatopathology, LLC
• Southern Medical Specialists, LLC
• Southern Surgical Assistants LLC
• Sovereign Rehabilitation of Cumming, LLC
• Laura J Sparks, P.T.
• Speech Inception
• Roxanne Spencer, LPC

• Dental Clinic/Center in Cumming, GA
• Providers in Cumming, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.