NPIMap

Organization Active NPI

Children and Teen Dental Group

  • Pediatric Dentistry
  • Eastman, GA
National Provider Identifier
1396563185
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
CHILDREN AND TEEN DENTAL GROUP
Practice address
5106 Oak St
Eastman, GA 31023-6027
Phone
(478) 268-4959
NPI assigned
Sep 30, 2024
Organization subpart
Yes
Parent organization
CHILDREN AND TEEN DENTAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

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

Authorized official

Name
Brian Smith
Title
Ceo
Phone
(470) 750-4866

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

5106 Oak St
Eastman, GA 31023-6027

Mailing address

2300 Lakeview Pkwy Ste 250
Alpharetta, GA 30009-3954
Phone (470) 750-4866

Other names 1

  • American Dental of Eastman Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Children and Teen Dental Group8 organizations share this tax ID, including this one
Part of
Children and Teen Dental Group

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1727654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783382400000",
    "number": "1396563185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 LAKEVIEW PKWY STE 250",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300093954",
            "telephone_number": "470-750-4866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5106 OAK ST",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236027",
            "telephone_number": "478-268-4959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN AND TEEN DENTAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN AND TEEN DENTAL GROUP",
        "enumeration_date": "2024-09-30",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "470-750-4866"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "American Dental of Eastman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eastman, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; 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.