Childrens Dental Village, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN014199 Issued in GA

Legal business name

CHILDRENS DENTAL VILLAGE, LLC

Practice address

9420 Willeo Rd
Suite 104
Roswell, GA 30075-6772

Phone

(678) 352-8108

Fax

(678) 352-8107

NPI assigned

Dec 12, 2014

Organization subpart

No

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

Authorized official

Name

Priya Madhiwala, DMD

Title

Dentist/Owner

Phone

(678) 352-8108

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1418342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419206400000",
    "number": "1356749964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9420 WILLEO RD",
            "address_2": "SUITE 104",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300756772",
            "telephone_number": "678-352-8108",
            "fax_number": "678-352-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9420 WILLEO RD",
            "address_2": "SUITE 104",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300756772",
            "telephone_number": "678-352-8108",
            "fax_number": "678-352-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS DENTAL VILLAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-12",
        "last_updated": "2014-12-22",
        "status": "A",
        "authorized_official_last_name": "MADHIWALA",
        "authorized_official_first_name": "PRIYA",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "678-352-8108",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN014199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1861641698",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003106680",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryll Ann Thompson LPC LLC
• Connie Cheung, DPT, MPH, RD/LD
• Lisa Cheyette, PHD
• Children for Dentistry of Roswell, LLC
• Children'S Dentistry of Roswell
• Chill Out, LLC
• Cheryl Chineme
• Chinese Medical Clinic LLC
• Ana Isabel Chiprez, CMT
• Thomas Chitwood III, CRNA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2014; 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.