Main Street Dental Group PC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DN012689 Issued in GA

Legal business name

MAIN STREET DENTAL GROUP PC

Practice address

848 Main St
Forest Park, GA 30297-1465

Phone

(404) 366-3724

Fax

(404) 366-4271

NPI assigned

Mar 31, 2008

Organization subpart

No

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

Authorized official

Name

Juan J Solano, D.D.S.NPI 1548337967

Title

President

Phone

(404) 366-3724

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

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.

• Juan J Solano, DDS

  • Dentist
  • Lilburn, GA
  • NPI 1548337967
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206921600000",
    "number": "1427220458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "848 MAIN ST",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302971465",
            "telephone_number": "404-366-3724",
            "fax_number": "404-366-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "848 MAIN ST",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302971465",
            "telephone_number": "404-366-3724",
            "fax_number": "404-366-4271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-31",
        "last_updated": "2008-03-31",
        "status": "A",
        "authorized_official_last_name": "SOLANO",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-366-3724",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "DN012689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Living Hope Residence, LLC
• Daphne M Lofton, PHARMD
• Glory Jean Logan-Brown
• Shweta Navneet Maheshwari, D.O.
• Vinh Mai, RPH
• Amanda Malayter
• Claudine Moma Malonga, DNP, C-PNP-PC
• Crystal Mercia Malvoisin, M.D.
• Manchester Orthopedic Inc.
• Arlene Martin

• Orthodontics and Dentofacial Orthopedics Dentistry in Forest Park, GA
• Providers in Forest Park, GA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.