Active NPI
Daniel Tesfa Redie, DDS
- Dentist
- Riverdale, GA
National Provider Identifier
1467558650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN012618
- Practice address
- 1849 Hwy 138
Riverdale, GA 30296 - Phone
- (770) 996-5850
- Fax
- (770) 996-5851
- NPI assigned
- Sep 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN012618 | GA | Primary |
Addresses
Primary practice location
1849 Hwy 138
Riverdale, GA 30296
Mailing address
1849 Hwy 138
Riverdale, GA 30296
Phone (770) 996-5850
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DN012618 | Other | GA | GA DENTAL LICENSE |
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 |
|---|---|---|---|
| DN012618 | GA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Daniel Redie General Dentistry | Past | Accepting new patients | |
| Sleep Impressions, LLC | Dentist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Riverdale, GA
- NPI 1295908614
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1467558650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1849 HWY 138",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "30296",
"telephone_number": "770-996-5850",
"fax_number": "770-996-5851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1849 HWY 138",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "30296",
"telephone_number": "770-996-5850",
"fax_number": "770-996-5851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDIE",
"first_name": "DANIEL",
"middle_name": "TESFA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-15",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN012618",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GA DENTAL LICENSE",
"identifier": "DN012618",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverdale, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.