NPIMap

Organization Active NPI

Main Street Dentistry PC

  • Dentist
  • Alpharetta, GA
National Provider Identifier
1457420937
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
11529 Issued in GA
Legal business name
MAIN STREET DENTISTRY PC
Practice address
366 North Main Street
Suite 200
Alpharetta, GA 30004
Phone
(770) 475-6136
Fax
(770) 475-5037
NPI assigned
Nov 7, 2006
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
Imad Sabbagh, DDSNPI 1578645941
Title
President Ceo
Phone
(770) 475-6136

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 11529 GA Primary

Addresses

Primary practice location

366 North Main Street
Suite 200
Alpharetta, GA 30004

Mailing address

366 North Main Street
Suite 200
Alpharetta, GA 30004
Phone (770) 475-6136

National Provider Directory

National Provider Directory

Locations

366 N Main St
Ste 200
Alpharetta, GA 30009
Phone (770) 203-0869

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457420937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 NORTH MAIN STREET",
            "address_2": "SUITE 200",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "30004",
            "telephone_number": "770-475-6136",
            "fax_number": "770-475-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "366 NORTH MAIN STREET",
            "address_2": "SUITE 200",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "30004",
            "telephone_number": "770-475-6136",
            "fax_number": "770-475-5037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SABBAGH",
        "authorized_official_first_name": "IMAD",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "770-475-6136",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "11529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

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.