NPIMap

Organization Active NPI

Lilburn Dental Group, L.L.C.

  • General Practice Dentistry
  • Lilburn, GA
National Provider Identifier
1346322989
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LILBURN DENTAL GROUP, L.L.C.
Practice address
912 Killian Hill Rd SW
Suite 100
Lilburn, GA 30047-3138
Phone
(770) 923-3966
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Richard Gangwisch, D.D.S.NPI 1255355145
Title
Member
Phone
(770) 923-3966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

912 Killian Hill Rd SW
Suite 100
Lilburn, GA 30047-3138

Mailing address

912 Killian Hill Rd SW
Suite 100
Lilburn, GA 30047-3138
Phone (770) 923-3966

National Provider Directory

National Provider Directory

Locations

912 Killian Hill Rd SW
Ste 100
Lilburn, GA 30047
Phone (770) 923-3966

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346322989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 KILLIAN HILL RD SW",
            "address_2": "SUITE 100",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473138",
            "telephone_number": "770-923-3966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 KILLIAN HILL RD SW",
            "address_2": "SUITE 100",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473138",
            "telephone_number": "770-923-3966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILBURN DENTAL GROUP, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GANGWISCH",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "770-923-3966",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lilburn, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.