NPIMap

Organization Active NPI

South East Dental

  • General Practice Dentistry
  • Chamlee, GA
National Provider Identifier
1427277458
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SOUTH EAST DENTAL
Practice address
4649 Buford Hwy
Chamlee, GA 30341
Phone
(770) 452-1400
NPI assigned
Apr 25, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Mrs. Jacqueline Tuyen Pham, DMDNPI 1609096049
Title
President
Phone
(770) 452-1400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X GA Primary

Addresses

Primary practice location

4649 Buford Hwy
Chamlee, GA 30341

Mailing address

4649 Buford Hwy
Chamlee, GA 30341
Phone (770) 452-1400

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427277458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4649 BUFORD HWY",
            "city": "CHAMLEE",
            "state": "GA",
            "postal_code": "30341",
            "telephone_number": "770-452-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4649 BUFORD HWY",
            "city": "CHAMLEE",
            "state": "GA",
            "postal_code": "30341",
            "telephone_number": "770-452-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH EAST DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "TUYEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-452-1400",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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.