Kennestone Periodontics of Marietta, PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

10742 Issued in GA

Legal business name

KENNESTONE PERIODONTICS OF MARIETTA, PC

Practice address

611 Campbell Hill St NW
Suite 102
Marietta, GA 30060-1386

Phone

(770) 422-0642

Fax

(770) 422-0643

NPI assigned

Feb 8, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Peter C Shatz, DDSNPI 1982798716

Title

President

Phone

(770) 422-0642

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Practitioners 2

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

• Peter Clifford Shatz, D.D.S.

  • Periodontics
  • Marietta, GA
  • NPI 1982798716
  NPD (past) Authorized official
• Lee Howard Silverstein, D.D.S., M.S.

  • Periodontics
  • Atlanta, GA
  • NPI 1811082183
  NPD (past)

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

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297123200000",
    "number": "1316243389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2070 S PARK PL SE",
            "address_2": "SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303392045",
            "telephone_number": "770-952-5432",
            "fax_number": "770-952-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 CAMPBELL HILL ST NW",
            "address_2": "SUITE 102",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601386",
            "telephone_number": "770-422-0642",
            "fax_number": "770-422-0643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNESTONE PERIODONTICS OF MARIETTA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-08",
        "last_updated": "2011-02-08",
        "status": "A",
        "authorized_official_last_name": "SHATZ",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-422-0642",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "11384",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "10742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI NUMBER",
            "identifier": "1982798716",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI NUMBER",
            "identifier": "1811082183",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kennestone Hospital, Inc. (Wellstar Windy Hill Hospital)
• Kennestone Internal Medicine Associates PC
• Kennestone Medical Inc.
• Kennestone Neurology Associates, P.C.
• Kennestone North Dental Associates
• Kenneth C Molkner MD PC
• Kenneth O Logan, D.C.,P.C. (Logan Chiropractic Life Center)
• Patricia Anne Kennington, PH.D.
• Kennstar LLC (Kennstone Chiropractic Wellness Center)
• Kent D Vanderslice DC PC

• Periodontics in Marietta, GA
• Providers in Marietta, GA by specialty
• Periodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2011; 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.