Atlanta Dental Spa

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ATLANTA DENTAL SPA

Practice address

2556 Apple Valley Rd NE Ste 250
Brookhaven, GA 30319-5432

Phone

(770) 998-3838

Fax

(678) 550-9639

NPI assigned

Nov 27, 2024

Organization subpart

No

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

Authorized official

Name

Kimberly Elston

Title

Chief Operating Officer

Phone

(586) 491-3861

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1732665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732665600000",
    "number": "1346066974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2556 APPLE VALLEY RD NE STE 250",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303195432",
            "telephone_number": "770-998-3838",
            "fax_number": "678-550-9639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2556 APPLE VALLEY RD NE STE 250",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303195432",
            "telephone_number": "770-998-3838",
            "fax_number": "678-550-9639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTA DENTAL SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-27",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A",
        "authorized_official_last_name": "ELSTON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "586-491-3861"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.