Parkside Dental Practice

Primary specialty

Public Health or Welfare AgencyTaxonomy code 251K00000X

License

GA8697 Issued in GA

Legal business name

PARKSIDE DENTAL PRACTICE

Practice address

410 Stevens Entry
Peachtree City, GA 30269

Phone

(770) 487-8882

Fax

(770) 486-9469

NPI assigned

Sep 26, 2006

Organization subpart

No

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

Authorized official

Name

Stephen L Matlaga DDS Gen PTR, DDS

Title

Owner

Phone

(770) 487-8882

Specialties & licenses 1

Addresses

Tax ID family

Parkside Dental Practice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Parkside Dental Practice

  • Health Maintenance Organization
  • Peachtree City, GA
  • NPI 1881017085
  NPD tax ID

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1275634487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 STEVENS ENTRY",
            "address_2": "PO BOX 2606",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "30269",
            "telephone_number": "770-487-8882",
            "fax_number": "770-486-9469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 STEVENS ENTRY",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "30269",
            "telephone_number": "770-487-8882",
            "fax_number": "770-486-9469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE DENTAL PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "MATLAGA DDS GEN PTR",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-487-8882",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "GA",
            "license": "GA8697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sathiya Priya Palanisamy
• Hardik Parekh, M.D.
• Sarah Noel Parent
• Precious Parham
• Janice Carmen Park, DMD
• Parkside Dental Practice
• Parkside Dental Practice Partners, P.C.
• Parkside Dental Practice Partners, P.C.
• Lisa Parsons, NP
• Pate & Sons, Inc.

• Public Health or Welfare Agency in Peachtree City, GA
• Providers in Peachtree City, GA by specialty
• Public Health or Welfare Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.