NPIMap

Organization Active NPI

Ga Prime Dental, L.L.C.

  • Dentist
  • Fort Oglethorpe, GA
National Provider Identifier
1285084715
Registry record updated Jun 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
GA PRIME DENTAL, L.L.C.
Practice address
17 Parkway Dr
Fort Oglethorpe, GA 30742-4249
Phone
(706) 944-3122
Fax
(706) 861-7946
NPI assigned
Jun 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2016

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

Authorized official

Name
Jennifer La Duc
Title
Provider Relations
Phone
(315) 454-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

17 Parkway Dr
Fort Oglethorpe, GA 30742-4249

Mailing address

PO Box 3189
Syracuse, NY 13220-3189
Phone (315) 454-6000

Other names 1

  • Aspen Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465948800000",
    "number": "1285084715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "315-454-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 PARKWAY DR",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307424249",
            "telephone_number": "706-944-3122",
            "fax_number": "706-861-7946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GA PRIME DENTAL, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-06-15",
        "status": "A",
        "authorized_official_last_name": "LA DUC",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PROVIDER RELATIONS",
        "authorized_official_telephone_number": "315-454-6000"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspen Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Oglethorpe, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; 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.