PCP Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PCP DENTAL LLC

Practice address

890 Dawsonville Hwy
Ste F
Gainesville, GA 30501-2607

Phone

(678) 928-3219

Fax

(770) 532-6391

NPI assigned

Dec 2, 2016

Organization subpart

No

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

Authorized official

Name

Jennifer La Duc

Title

Provider Relations

Phone

(315) 454-6000

Specialties & licenses 1

Addresses

Other names 1

• Aspen Dental Doing business as

Locations

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

{
    "created_epoch": "1480636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480636800000",
    "number": "1477096832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "315-454-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 DAWSONVILLE HWY",
            "address_2": "STE F",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012607",
            "telephone_number": "678-928-3219",
            "fax_number": "770-532-6391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCP DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-02",
        "last_updated": "2016-12-02",
        "status": "A",
        "authorized_official_last_name": "LA DUC",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PROVIDER RELATIONS",
        "authorized_official_telephone_number": "315-454-6000"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspen Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John David Patton Jr., MD
• Andrea Marie Paul, LCSW
• Larry Jeffrey Payne, M.D.
• Robert Dale Payne, MSPT
• PBT Dental LLC
• PCR-DX, LLC
• Peaceful Hearts Enterprise Inc
• Peachstate Health Management LLC
• Peachtree Childrens Dentistry Gainesville LLC
• Karen A Peacock, CRNA

• Dentist in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; 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.