Kennesaw Modern Dentistry, PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

KENNESAW MODERN DENTISTRY, PC

Doing business as

Kennesaw Modern Dentistry

Practice address

1125 Ernest W Barrett Pkwy NW BLDG 200
Kennesaw, GA 30144-4535

Phone

(678) 832-0527

Fax

(678) 835-9729

NPI assigned

Mar 3, 2022

Last updated

Apr 26, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michelle Houston, DMD

Title

Owner

Phone

(678) 832-0527

Specialties & licenses 1

Addresses

Other names 1

• Kennesaw Modern Dentistry Doing business as

Locations

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.

• Anjali Patel

  • Dentist
  • Kennesaw, GA
  • NPI 1386535219
  NPD

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

{
    "created_epoch": "1646265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650931200000",
    "number": "1477200137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8500",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 ERNEST W BARRETT PKWY NW BLDG 200",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301444535",
            "telephone_number": "678-832-0527",
            "fax_number": "678-835-9729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNESAW MODERN DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-03",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A",
        "authorized_official_last_name": "HOUSTON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-832-0527",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennesaw Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kennesaw Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kennesaw Health and Wellness Center LLC (Kennesaw Gynecology)
• Kennesaw Healthcare Services, LLC (Treatment Center of Kennesaw)
• Kennesaw Luxary Hair Boutique
• Kennesaw Medical Supplies Inc (Mechanical Equipment Aids Inc)
• Kennesaw Medical Supply
• Kennesaw Mountain Dental Associates
• Kennesaw Mountain Medical Group
• Kennesaw Pediatric Dentistry
• Kennesaw Pediatrics
• Kennesaw RX LLC (Kennesaw Pharmacy)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2022; 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.