Organization Active NPI

Dental Wellness Center of Marietta, LLC

  • Dental Clinic/Center
  • Marietta, GA
National Provider Identifier
1356809966
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
DENTAL WELLNESS CENTER OF MARIETTA, LLC
Practice address
2100 Roswell Rd Ste a&B
Marietta, GA 30062-0810
Phone
(678) 909-1225
Fax
(912) 226-3489
NPI assigned
Mar 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Mrs. Christie D Lawrence
Title
Corporate Operations Coordinator
Phone
(912) 920-5577

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

2100 Roswell Rd Ste a&B
Marietta, GA 30062-0810

Mailing address

PO Box 60339
Savannah, GA 31420-0339
Phone (912) 920-5577

Other identifiers 2

IdentifierTypeStateIssuer
DN010747OtherGASTATE LICENSE
1497918759OtherGANPI

National Provider Directory

National Provider Directory

Locations

2100 Roswell Rd
Ste Ab
Marietta, GA 30062
Phone (678) 909-1225

NPI Registry JSON

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

{
    "created_epoch": "1551657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1356809966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60339",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314200339",
            "telephone_number": "912-920-5577",
            "fax_number": "912-226-3489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 ROSWELL RD STE A&B",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300620810",
            "telephone_number": "678-909-1225",
            "fax_number": "912-226-3489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL WELLNESS CENTER OF MARIETTA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-04",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHRISTIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CORPORATE OPERATIONS COORDINATOR",
        "authorized_official_telephone_number": "912-920-5577",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "DN010747",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1497918759",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.