NPIMap

Organization Active NPI

Ulysses L. Marable III, DMD, LLC

Doing business as Fantastic Smiles

  • Dentist
  • Fort Valley, GA
National Provider Identifier
1316208341
Registry record updated Jun 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
13223 Issued in GA
Legal business name
ULYSSES L. MARABLE III, DMD, LLC
Doing business as
Fantastic Smiles
Practice address
1030 Peach Parkway, Ste 9
Fort Valley, GA 31030
Phone
(478) 825-3000
Fax
(478) 825-3099
NPI assigned
Jun 6, 2012
Last updated
Jun 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2012

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

Authorized official

Name
Dr. Ulysses L Marable III, DMDNPI 1891905683
Title
Owner/Member
Phone
(478) 825-3000

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 13223 GA Primary

Addresses

Primary practice location

1030 Peach Parkway, Ste 9
Fort Valley, GA 31030

Mailing address

1030 Peach Parkway, Ste 9
Fort Valley, GA 31030
Phone (478) 825-3000

Other names 1

  • Fantastic Smiles Doing business as

National Provider Directory

National Provider Directory

Locations

1030 Peach Pkwy
Ste 9
Fort Valley, GA 31030
Phone (478) 825-3000

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": "1338940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338940800000",
    "number": "1316208341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 PEACH PARKWAY, STE 9",
            "city": "FORT VALLEY",
            "state": "GA",
            "postal_code": "31030",
            "telephone_number": "478-825-3000",
            "fax_number": "478-825-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 PEACH PARKWAY, STE 9",
            "city": "FORT VALLEY",
            "state": "GA",
            "postal_code": "31030",
            "telephone_number": "478-825-3000",
            "fax_number": "478-825-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULYSSES L. MARABLE III, DMD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-06",
        "last_updated": "2012-06-06",
        "status": "A",
        "authorized_official_last_name": "MARABLE",
        "authorized_official_first_name": "ULYSSES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "478-825-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "13223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fantastic Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Valley, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; 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.