NPIMap

Organization Active NPI

Kool Smiles, PC

  • General Practice Dentistry
  • Valdosta, GA
National Provider Identifier
1457448987
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN012573 Issued in GA
Legal business name
KOOL SMILES, PC
Practice address
2113 Bemiss Road
Valdosta, GA 31602
Phone
(800) 920-9947
Fax
(678) 904-5666
NPI assigned
Oct 6, 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
Dr. Thien CHI Pham, DDS
Title
Owner
Phone
(404) 229-6898

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN012573 GA Primary

Addresses

Primary practice location

2113 Bemiss Road
Valdosta, GA 31602

Mailing address

400 Galleria Pkwy SE
Suite 800
Atlanta, GA 30339-5980
Phone (770) 916-5028

National Provider Directory

National Provider Directory
Tax ID family
Candler Road Dental PC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2113 Bemiss Rd
Valdosta, GA 31602

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457448987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 GALLERIA PKWY SE",
            "address_2": "SUITE 800",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395980",
            "telephone_number": "770-916-5028",
            "fax_number": "678-302-7485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2113 BEMISS ROAD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31602",
            "telephone_number": "800-920-9947",
            "fax_number": "678-904-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOL SMILES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "THIEN",
        "authorized_official_middle_name": "CHI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-229-6898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, 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.