MP Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MP DENTAL, LLC

Doing business as

Jefferson Dental Care

Practice address

1679 Old Pendergrass Rd
Jefferson, GA 30549-2705

Phone

(770) 297-0401

NPI assigned

Jan 30, 2018

Organization subpart

No

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

Authorized official

Name

Tiffany Crowe

Title

Director of Operations

Phone

(770) 297-0401

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jefferson Dental Care Doing business as

Locations

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

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517270400000",
    "number": "1366940884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1679 OLD PENDERGRASS RD",
            "city": "JEFFERSON",
            "state": "GA",
            "postal_code": "305492705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1679 OLD PENDERGRASS RD",
            "city": "JEFFERSON",
            "state": "GA",
            "postal_code": "305492705",
            "telephone_number": "770-297-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MP DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-30",
        "last_updated": "2018-01-30",
        "status": "A",
        "authorized_official_last_name": "CROWE",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "770-297-0401"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1902238926",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Rebecca Lynn McLeish, FNP-C
• Annette Raquel McMichael, CSFA
• Medlink Georgia Inc (MedLink Jefferson)
• Milestone Pediatric Therapy Services, Inc.
• Nathalie Mize, RN
• Kellie Brandenburg Mullins, PT
• Molly Musselwhite, PA-C
• William Robert Newell, DMD, PC
• Noah's Ark Homecare, Inc.
• Northeast Georgia Surgical Assisting

• Dentist in Jefferson, GA
• Providers in Jefferson, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2018; 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.