Princeton Dental Group-Loganville

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN011481 Issued in GA

Legal business name

PRINCETON DENTAL GROUP-LOGANVILLE

Practice address

4353 Atlanta Hwy
Loganville, GA 30052-3214

Phone

(770) 554-0848

Fax

(770) 554-4569

NPI assigned

Nov 7, 2011

Last updated

Sep 28, 2014By 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. Kevin BlairNPI 1477695807

Title

Owner/Operator

Phone

(404) 324-2012

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin F Blair, DDS

  • General Practice Dentistry
  • Loganville, GA
  • NPI 1477695807
  Authorized official Same address or phone

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

{
    "created_epoch": "1320624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411862400000",
    "number": "1275810129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 WATER SHINE WAY",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "30078",
            "telephone_number": "404-324-2012",
            "fax_number": "678-344-4642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4353 ATLANTA HWY",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300523214",
            "telephone_number": "770-554-0848",
            "fax_number": "770-554-4569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCETON DENTAL GROUP-LOGANVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-07",
        "last_updated": "2014-09-28",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "404-324-2012",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN011481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Loganville, GA
• Providers in Loganville, 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 Sep 28, 2014; 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.