NPIMap

Organization Active NPI

My East Cobb Dentist, PC

  • General Practice Dentistry
  • Marietta, GA
National Provider Identifier
1477688166
Registry record updated Dec 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
011490 Issued in GA
Legal business name
MY EAST COBB DENTIST, PC
Practice address
4200 Providence Rd
Marietta, GA 30062-6129
Phone
(770) 579-6400
NPI assigned
Feb 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2012

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

Authorized official

Name
Dr. Erik Klein, DDSNPI 1982949228
Title
President
Phone
(770) 579-6400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 011490 GA Primary

Addresses

Primary practice location

4200 Providence Rd
Marietta, GA 30062-6129

Mailing address

4200 Providence Rd
Marietta, GA 30062-6129
Phone (770) 579-6400

National Provider Directory

National Provider Directory

Locations

4200 Providence Rd
Marietta, GA 30062
Phone (770) 579-6400

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354579200000",
    "number": "1477688166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 PROVIDENCE RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300626129",
            "telephone_number": "770-579-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 PROVIDENCE RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300626129",
            "telephone_number": "770-579-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY EAST COBB DENTIST, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2012-12-04",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "ERIK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-579-6400",
        "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": "011490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.