Pediatric Dentistry of Newnan, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PEDIATRIC DENTISTRY OF NEWNAN, LLC

Practice address

2401 Newnan Crossing Blvd E Ste 210
Newnan, GA 30265-2409

Phone

(770) 251-5777

NPI assigned

Jan 18, 2024

Organization subpart

No

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

Authorized official

Name

Jenny Garcia Rocha

Title

Sr Team Lead

Phone

(972) 836-9378

Specialties & licenses 1

Addresses

Other names 1

• Pediatric Dentistry of Newnan Doing business as

Locations

Practitioners 2

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

• Arlene D Soberano, DMD

  • Dentist
  • Newnan, GA
  • NPI 1942305537
  NPD
• Kim Jackson Mathews, DMD

  • Pediatric Dentistry
  • Newnan, GA
  • NPI 1639349970
  NPD (past)

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

{
    "created_epoch": "1705536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1336900166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 NEWNAN CROSSING BLVD E STE 210",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652409",
            "telephone_number": "770-251-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 NEWNAN CROSSING BLVD E STE 210",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652409",
            "telephone_number": "770-251-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF NEWNAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-18",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "GARCIA ROCHA",
        "authorized_official_first_name": "JENNY",
        "authorized_official_title_or_position": "SR TEAM LEAD",
        "authorized_official_telephone_number": "972-836-9378"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dentistry of Newnan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peachtree Immediate Care FP, LLC
• Jenna Pealor
• Mashelle Annette Pearson
• Pediakare of Newnan, Inc
• Pediatric Associates of Newnan P.C.
• Tia Chalise Penn-Tabor
• Gianna Rose Penton-Depretoro
• Harry Jacobi Peoples II, DMD
• Chelsea Clark Pepples, PHARMD
• Periodontics & Dental Implants, LLC

• Pediatric Dentistry in Newnan, GA
• Providers in Newnan, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.