Active NPI
Mariel Nortick, DDS
- Pediatric Dentistry
- Jonesboro, GA
National Provider Identifier
1336410182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DNO14492
- Practice address
- 435 Arrowhead Blvd
Jonesboro, GA 30236-1219 - Phone
- (404) 389-1950
- Fax
- (678) 444-4152
- NPI assigned
- Jan 24, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5886 | AL | |
| Pediatric Dentistry | 1223P0221X | DNO14492 | GA | Primary |
Addresses
Primary practice location
435 Arrowhead Blvd
Jonesboro, GA 30236-1219
Mailing address
1350 Spring Street
Ste 600
Atlanta, GA 30309-2870
Phone (404) 389-1950
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 |
|---|---|---|---|
| 5886 | AL | MD | Dentist |
| DNO14492 | GA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397001600000",
"number": "1336410182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 SPRING STREET",
"address_2": "STE 600",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303092870",
"telephone_number": "404-389-1950",
"fax_number": "678-444-4152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "435 ARROWHEAD BLVD",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302361219",
"telephone_number": "404-389-1950",
"fax_number": "678-444-4152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NORTICK",
"first_name": "MARIEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-24",
"last_updated": "2014-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AL",
"license": "5886",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "GA",
"license": "DNO14492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.