Parkside Pediatric and Orthodontic Care Inc

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PARKSIDE PEDIATRIC AND ORTHODONTIC CARE INC

Practice address

155 Carnegie PL Ste 201a
Fayetteville, GA 30214-3981

Phone

(678) 228-4266

Fax

(404) 521-4120

NPI assigned

Aug 8, 2023

Organization subpart

No

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

Authorized official

Name

Tarvoria Russ

Title

Operations Manager

Phone

(404) 631-7303

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1691452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691452800000",
    "number": "1366125395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 CARNEGIE PL STE 201A",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302143981",
            "telephone_number": "678-228-4266",
            "fax_number": "404-521-4120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 CARNEGIE PL STE 201A",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302143981",
            "telephone_number": "678-228-4266",
            "fax_number": "404-521-4120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE PEDIATRIC AND ORTHODONTIC CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-08",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A",
        "authorized_official_last_name": "RUSS",
        "authorized_official_first_name": "TARVORIA",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "404-631-7303"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin U Park, MD
• Minhye Park, NP
• Joshua Ridikas Parker
• Julie Hall Parker, P.T.A.
• Roberta Jean Parker, DPM
• Kathryn Perez Parr, NP
• Clarence A Parrott, DDS
• Brittney Shay Pasko, FNP-C
• Aniruddh Patel
• Anjali Harish Patel, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; 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.