NPIMap

Organization Active NPI

Perry Street Dental, P.C.

  • Dentist
  • Newnan, GA
National Provider Identifier
1407208291
Registry record updated Jul 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PERRY STREET DENTAL, P.C.
Practice address
53 Perry St
Newnan, GA 30263-1935
Phone
(770) 251-3465
NPI assigned
Jul 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2016

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

Authorized official

Name
Thomas F. Moynahan, D.M.D.NPI 1144439167
Title
President
Phone
(770) 251-3465

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X Primary
EndodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223E0200X
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

53 Perry St
Newnan, GA 30263-1935

Mailing address

1090 Northchase Pkwy SE Ste 150
Marietta, GA 30067-6407
Phone (770) 916-5031

National Provider Directory

National Provider Directory

Locations

53 Perry St
Newnan, GA 30263
Phone (770) 251-3465

Practitioners & affiliated clinicians

Practitioners 2

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": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467763200000",
    "number": "1407208291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 NORTHCHASE PKWY SE STE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676407",
            "telephone_number": "770-916-5031",
            "fax_number": "678-247-7966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 PERRY ST",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302631935",
            "telephone_number": "770-251-3465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY STREET DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-06",
        "last_updated": "2016-07-06",
        "status": "A",
        "authorized_official_last_name": "MOYNAHAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-251-3465",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newnan, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.