Imagix Dental Management Group IV LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DNO09491 Issued in GA

Legal business name

IMAGIX DENTAL MANAGEMENT GROUP IV LLC

Practice address

1345 Hembree Rd
Roswell, GA 30076-3816

Phone

(770) 777-7427

NPI assigned

Mar 18, 2008

Organization subpart

No

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

Authorized official

Name

Eugene Witkin, DDS

Title

Owner

Phone

(770) 777-7427

Specialties & licenses 1

Addresses

Other names 1

• Imagix IV Doing business as

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

{
    "created_epoch": "1205798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205798400000",
    "number": "1407027477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345 HEMBREE RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300763816",
            "telephone_number": "770-777-7427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 HEMBREE RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300763816",
            "telephone_number": "770-777-7427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGIX DENTAL MANAGEMENT GROUP IV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-18",
        "last_updated": "2008-03-18",
        "status": "A",
        "authorized_official_last_name": "WITKIN",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-777-7427",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DNO09491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Imagix IV",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; 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.