Organization Active NPI

Douglas J. Deuchar, D.M.D., P.C.

  • General Practice Dentistry
  • Kennesaw, GA
National Provider Identifier
1396969721
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN011540 Issued in GA
Legal business name
DOUGLAS J. DEUCHAR, D.M.D., P.C.
Practice address
3903 Jiles Rd.
BLDG. 100, Ste.111
Kennesaw, GA 30144
Phone
(770) 792-9190
NPI assigned
Apr 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Douglas J. Deuchar J Deuchar, D.M.D.
Title
Owner
Phone
(770) 792-9190

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN011540 GA Primary

Addresses

Primary practice location

3903 Jiles Rd.
BLDG. 100, Ste.111
Kennesaw, GA 30144

Mailing address

3903 Jiles Rd.
BLDG. 100, Ste.111
Kennesaw, GA 30144
Phone (770) 792-9190

National Provider Directory

National Provider Directory

Locations

3903 Jiles Rd NW
Ste 111
Kennesaw, GA 30144
Phone (770) 792-9190

Practitioners & affiliated clinicians

Practitioners 1

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": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396969721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 JILES RD.",
            "address_2": "BLDG. 100, STE.111",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "30144",
            "telephone_number": "770-792-9190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 JILES RD.",
            "address_2": "BLDG. 100, STE.111",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "30144",
            "telephone_number": "770-792-9190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS J. DEUCHAR, D.M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEUCHAR",
        "authorized_official_first_name": "DOUGLAS J. DEUCHAR",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-792-9190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN011540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.