Individual provider Active NPI

Nael Badr Harfoush, DMD

  • General Practice Dentistry
  • Acworth, GA
National Provider Identifier
1356451371
Registry record updated Nov 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN012396 Issued in GA
Practice address
3950 Cobb Pkwy NW
Suite 402
Acworth, GA 30101-9532
Phone
(770) 966-9396
Fax
(770) 966-8774
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN012396 GA Primary

Addresses

Primary practice location

3950 Cobb Pkwy NW
Suite 402
Acworth, GA 30101-9532

Mailing address

6615 Hickory Flat Hwy
Suite 402
Canton, GA 30115-7237
Phone (770) 872-0548

Other identifiers 1

IdentifierTypeStateIssuer
269537165AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161116001929 GA Order and Referring Only - DentistPractitioner - Dentist 9436438397

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Pointe Dental Inc General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478736000000",
    "number": "1356451371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6615 HICKORY FLAT HWY",
            "address_2": "SUITE 402",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301157237",
            "telephone_number": "770-872-0548",
            "fax_number": "770-872-0548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 COBB PKWY NW",
            "address_2": "SUITE 402",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301019532",
            "telephone_number": "770-966-9396",
            "fax_number": "770-966-8774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARFOUSH",
        "first_name": "NAEL",
        "middle_name": "BADR",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2016-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269537165A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Acworth, GA

Sources for this page

Verify at the official NPI Registry.