Active NPI
Kevin Sean Short, DDS
- General Practice Dentistry
- Cumming, GA
National Provider Identifier
1306930607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN011242
- Practice address
- 1200 Bald Ridge Marina Rd
Suite 200
Cumming, GA 30041-8494 - Phone
- (770) 781-8650
- Fax
- (770) 781-2953
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN011242 | GA | Primary |
Addresses
Primary practice location
1200 Bald Ridge Marina Rd
Suite 200
Cumming, GA 30041-8494
Mailing address
PO Box 599
Cumming, GA 30028-0599
Phone (770) 781-8650
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 825012 | Other | GA | UNITED CONCORDIA |
| 4080537 | Other | TN | BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN011242 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cumming Dental Associates | General Practice | Past | Accepting new patients |
| Cumming Dental Associates, PC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Cumming, GA
- NPI 1255464384
-
- General Practice Dentistry
- Cumming, GA
- NPI 1760996656
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306930607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 599",
"city": "CUMMING",
"state": "GA",
"postal_code": "300280599",
"telephone_number": "770-781-8650",
"fax_number": "770-781-2953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 BALD RIDGE MARINA RD",
"address_2": "SUITE 200",
"city": "CUMMING",
"state": "GA",
"postal_code": "300418494",
"telephone_number": "770-781-8650",
"fax_number": "770-781-2953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHORT",
"first_name": "KEVIN",
"middle_name": "SEAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN011242",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "825012",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "4080537",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cumming, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.