Nova Dental, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DN013488 Issued in GA

Legal business name

NOVA DENTAL, PC

Practice address

1134 Senoia Rd Ste A2
Tyrone, GA 30290-1622

Phone

(770) 253-5885

NPI assigned

Mar 26, 2013

Last updated

Mar 26, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Juliane S Reynolds, DDS

Title

General Dentist

Phone

(770) 253-5885

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1364256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364256000000",
    "number": "1346582566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 JESSICA LN",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302637069",
            "telephone_number": "770-253-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1134 SENOIA RD STE A2",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302901622",
            "telephone_number": "770-253-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-26",
        "last_updated": "2013-03-26",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "JULIANE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "770-253-5885",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "DN013488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "S01262012767946",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Tyrone, GA
• Providers in Tyrone, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; 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.