Active NPI
Tara Tewogbade, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Snellville, GA
National Provider Identifier
1447454236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DN013995
- Practice address
- 3966 Annistown Rd
Snellville, GA 30039-6970 - Phone
- (770) 469-4192
- NPI assigned
- Jun 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DN013995 | GA | Primary |
| Dentist | 122300000X | 8254 | NC |
Addresses
Primary practice location
3966 Annistown Rd
Snellville, GA 30039-6970
Mailing address
3966 Annistown Rd
Snellville, GA 30039-6970
Phone (770) 469-4192
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8254 | NC | MD | Dentist |
| DN013995 | GA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762992000000",
"number": "1447454236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3966 ANNISTOWN RD",
"city": "SNELLVILLE",
"state": "GA",
"postal_code": "300396970",
"telephone_number": "770-469-4192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3966 ANNISTOWN RD",
"city": "SNELLVILLE",
"state": "GA",
"postal_code": "300396970",
"telephone_number": "770-469-4192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEWOGBADE",
"first_name": "TARA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-13",
"last_updated": "2025-11-13",
"certification_date": "2025-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "GA",
"license": "DN013995",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "8254",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Snellville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.