Avala Dental Providers

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN014034 Issued in GA

Legal business name

AVALA DENTAL PROVIDERS

Practice address

5495 Jimmy Carter Blvd.
Suite a-14
Norcross, GA 30093

Phone

(770) 368-9159

Fax

(770) 368-9119

NPI assigned

Mar 24, 2011

Organization subpart

Yes

Parent organization

COMFORT DENTAL LOUNGEAs reported in NPPES

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

Authorized official

Name

Dr. Tiffany Nicole Jamison, DDS

Title

Manager

Phone

(202) 714-8433

Specialties & licenses 1

Addresses

Other names 1

• comfort dental lounge Doing business as

Part of

Avala Dental Providers

Locations

Practitioners 1

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

• Dai Minh Le Nguyen, D.M.D.

  • Dentist
  • Norcross, GA
  • NPI 1649565979
  NPD (past)

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

{
    "created_epoch": "1300924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358812800000",
    "number": "1487953741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5495 JIMMY CARTER BLVD.",
            "address_2": "SUITE A-14",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5495 JIMMY CARTER BLVD.",
            "address_2": "SUITE A-14",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30093",
            "telephone_number": "770-368-9159",
            "fax_number": "770-368-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALA DENTAL PROVIDERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMFORT DENTAL LOUNGE",
        "enumeration_date": "2011-03-24",
        "last_updated": "2013-01-22",
        "status": "A",
        "authorized_official_last_name": "JAMISON",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "202-714-8433",
        "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": "DN014034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "comfort dental lounge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Norcross, GA
• Providers in Norcross, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2013; 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.