NPIMap

Organization Active NPI

J Michael Dierkes Family Orthodontics LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Roswell, GA
National Provider Identifier
1316107709
Registry record updated Dec 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
9675 Issued in GA
Legal business name
J MICHAEL DIERKES FAMILY ORTHODONTICS LLC
Practice address
910 Marietta Hwy
Suite
Roswell, GA 30075-6771
Phone
(678) 352-0919
Fax
(678) 352-8330
NPI assigned
Jun 10, 2008
Last updated
Dec 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2016

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

Authorized official

Name
Dr. John Michael Dierkes, DDS MS FICCMO NMDNPI 1831358795
Title
Pres
Phone
(678) 352-0919

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 9675 GA Primary

Addresses

Primary practice location

910 Marietta Hwy
Suite
Roswell, GA 30075-6771

Mailing address

910 Marietta Hwy
Suite
Roswell, GA 30075-6771
Phone (678) 352-0919

Other names 1

  • Dr John M Dierkes Other name

National Provider Directory

National Provider Directory

Locations

910 Marietta Hwy
Roswell, GA 30075
Phone (678) 352-0919

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480896000000",
    "number": "1316107709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 MARIETTA HWY",
            "address_2": "SUITE",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300756771",
            "telephone_number": "678-352-0919",
            "fax_number": "678-352-8330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 MARIETTA HWY",
            "address_2": "SUITE",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300756771",
            "telephone_number": "678-352-0919",
            "fax_number": "678-352-8330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J MICHAEL DIERKES FAMILY ORTHODONTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2016-12-05",
        "status": "A",
        "authorized_official_last_name": "DIERKES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "678-352-0919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MS FICCMO NMD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "9675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr John M Dierkes",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.