Individual provider Active NPI

Vishant Nath, D.M.D

  • Pediatric Dentistry
  • Roswell, GA
National Provider Identifier
1396710216
Registry record updated Oct 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN013057 Issued in GA
Practice address
10930 Crabapple Rd
Suite 106
Roswell, GA 30075-5813
Phone
(678) 352-1090
Fax
(770) 277-5637
NPI assigned
Feb 22, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DN013057 GA Primary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X DN013057 GA

Addresses

Primary practice location

10930 Crabapple Rd
Suite 106
Roswell, GA 30075-5813

Mailing address

2012 Ivey Chase Dr
Dacula, GA 30019-7884
Phone (770) 277-5637

Other identifiers 1

IdentifierTypeStateIssuer
761564386DMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN013057GAMDOrthodontics and Dentofacial Orthopedic Dentist

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477785600000",
    "number": "1396710216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2012 IVEY CHASE DR",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300197884",
            "telephone_number": "770-277-5637",
            "fax_number": "770-277-5637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10930 CRABAPPLE RD",
            "address_2": "SUITE 106",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300755813",
            "telephone_number": "678-352-1090",
            "fax_number": "770-277-5637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NATH",
        "first_name": "VISHANT",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2016-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013057",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "DN013057",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "761564386D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2016; 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.