Janice Carmen Park, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN122694 Issued in GA

Practice address

2513 Redwine Rd Ste C
Peachtree City, GA 30269-4420

Phone

(770) 486-1984

NPI assigned

Jun 15, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1457081101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 SAVANNAH DR",
            "city": "SENOIA",
            "state": "GA",
            "postal_code": "302762357",
            "telephone_number": "830-319-2761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2513 REDWINE RD STE C",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302694420",
            "telephone_number": "770-486-1984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JANICE",
        "middle_name": "CARMEN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-15",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN122694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca L Paffenroth, APRN
• Sathiya Priya Palanisamy
• Hardik Parekh, M.D.
• Sarah Noel Parent
• Precious Parham
• Parkside Dental Practice
• Parkside Dental Practice
• Parkside Dental Practice Partners, P.C.
• Parkside Dental Practice Partners, P.C.
• Lisa Parsons, NP

• General Practice Dentistry in Peachtree City, GA
• Providers in Peachtree City, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.