Providence Dental Spa of East Cobb, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PROVIDENCE DENTAL SPA OF EAST COBB, LLC

Doing business as

Providence Dental Spa of East Cobb

Practice address

670 Johnson Ferry Rd
Marietta, GA 30068-4627

Phone

(678) 801-6700

NPI assigned

Nov 18, 2024

Last updated

Nov 18, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

PROVIDENCE DENTAL LLCAs reported in NPPES

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

Authorized official

Name

Heather Taylor

Title

Director

Phone

(470) 309-8888

Specialties & licenses 1

Addresses

Other names 1

• Providence Dental Spa of East Cobb Doing business as

Part of

Providence Dental LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Providence Dental LLC

  • General Practice Dentistry
  • Macon, GA
  • NPI 1295189595
  NPPES parent name

Practitioners 1

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.

• David Chun-Chieh Wang, DMD

  • General Practice Dentistry
  • Marietta, GA
  • NPI 1992937981
  NPD

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

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1467277228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 JOHNSON FERRY RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684627",
            "telephone_number": "678-801-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 JOHNSON FERRY RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684627",
            "telephone_number": "678-801-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE DENTAL SPA OF EAST COBB, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE DENTAL LLC",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "470-309-8888"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Dental Spa of East Cobb",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Torre Marsha Prothro, PHD
• Provectus Health Strategies, LLC
• Allex Provens, MA
• Providence Rd Primary Care LLC
• Kaynessa Celena Providence, M.D.
• Provident Healthcare LLC
• Sandra L Pruett, CNP
• Lashanti Melba Pruitt, MA

• Dental Clinic/Center in Marietta, GA
• Providers in Marietta, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.