Conyers Dentures & Implant Center

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN012684 Issued in GA

Legal business name

CONYERS DENTURES & IMPLANT CENTER

Practice address

1916 Iris Drive, SW
Conyers, GA 30094

Phone

(770) 483-4469

Fax

(770) 922-0401

NPI assigned

Oct 10, 2007

Last updated

May 2, 2016By 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

Dr. Gordon Cleland Fraser Jr., DMDNPI 1306034871

Title

Dentist

Phone

(770) 483-4469

Specialties & licenses 2

Addresses

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.

• Gordon Cleland Fraser Jr., DMD

  • Periodontics
  • Conyers, GA
  • NPI 1306034871
  NPD (past) Authorized official

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462147200000",
    "number": "1487842951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2213",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "30269",
            "telephone_number": "770-483-4469",
            "fax_number": "770-922-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 IRIS DRIVE, SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "30094",
            "telephone_number": "770-483-4469",
            "fax_number": "770-922-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONYERS DENTURES & IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-10",
        "last_updated": "2016-05-02",
        "status": "A",
        "authorized_official_last_name": "FRASER",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "CLELAND",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "770-483-4469",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012684",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "DN012684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian N Conton, PT
• Cassandra Conton, LPC
• Conyers Chiropractic & Massage P.C.
• Conyers Dental Associates, LLC
• Conyers Dental LLC (Olde Town Dentistry)
• Conyers Endodontic Center PC (Conyers Endodontic Center)
• Conyers Family Practice Inc
• Conyers Ga Opco LLC (Westbury Center of Conyers for Nursing and Healing)
• Conyers Internal Medicine LLC
• Conyers Medical Clinic, PC

• Periodontics in Conyers, GA
• Providers in Conyers, GA by specialty
• Periodontics in Georgia

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