NPIMap

Organization Active NPI

Conyers Dental LLC

Doing business as Olde Town Dentistry

  • General Practice Dentistry
  • Conyers, GA
National Provider Identifier
1437748647
Registry record updated Mar 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CONYERS DENTAL LLC
Doing business as
Olde Town Dentistry
Practice address
1317 Milstead Ave NE
Conyers, GA 30012-3829
Phone
(770) 760-0036
Fax
(770) 760-9100
NPI assigned
Jan 12, 2021
Last updated
Mar 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2025

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

Authorized official

Name
Shawn C Edwards, DMDNPI 1265480404
Title
Owner
Phone
(864) 859-0111

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

1317 Milstead Ave NE
Conyers, GA 30012-3829

Mailing address

415 S Pendleton St
Easley, SC 29640-3051
Phone (864) 859-0111

Other names 1

  • Olde Town Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1317 Milstead Ave NE
Conyers, GA 30012
Phone (770) 760-0036

Practitioners & affiliated clinicians

Practitioners 4

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": "1610409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742256000000",
    "number": "1437748647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S PENDLETON ST",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296403051",
            "telephone_number": "864-859-0111",
            "fax_number": "864-859-0112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 MILSTEAD AVE NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123829",
            "telephone_number": "770-760-0036",
            "fax_number": "770-760-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONYERS DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-12",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-859-0111",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olde Town Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; 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.