Smalltown Dental Atlanta

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SMALLTOWN DENTAL ATLANTA

Practice address

205 S Race St
Atlanta, IL 61723-7586

Phone

(217) 648-2828

NPI assigned

Jun 4, 2019

Last updated

Jun 29, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

SMALLTOWN DENTAL MANAGEMENT LLCAs reported in NPPES

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

Authorized official

Name

Luke Overcash

Title

Operations Manager

Phone

(309) 370-5853

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gabrielle Coe, DMD

  • General Practice Dentistry
  • Atlanta, IL
  • NPI 1306404389
  NPD (past)

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

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593388800000",
    "number": "1417515453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 445",
            "city": "ATLANTA",
            "state": "IL",
            "postal_code": "617230445",
            "telephone_number": "217-648-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 S RACE ST",
            "city": "ATLANTA",
            "state": "IL",
            "postal_code": "617237586",
            "telephone_number": "217-648-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMALLTOWN DENTAL ATLANTA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SMALLTOWN DENTAL MANAGEMENT LLC",
        "enumeration_date": "2019-06-04",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A",
        "authorized_official_last_name": "OVERCASH",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "309-370-5853"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Allen Heriford, LPC, CADC
• Michelle Marie Maris, M.S.
• Danielle Christine Mont, PTA
• Sherman's Pharmacy
• Small Miracles Chiropractic Clinic SC
• Nancy Anne Wrage, DEVELOPMENTAL THERAP

• Dental Clinic/Center in Atlanta, IL
• Providers in Atlanta, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 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.