East Victory Drive Dental Group, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015152 Issued in GA

Legal business name

EAST VICTORY DRIVE DENTAL GROUP, LLC

Doing business as

Savannah Smiles Youth Dentistry

Practice address

2127 E Victory Dr
Savannah, GA 31404-3917

Phone

(912) 443-6013

Fax

(912) 443-6014

NPI assigned

Oct 12, 2016

Last updated

Oct 12, 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. Paul M. Elkin, DDS

Title

President and Owner

Phone

(615) 988-2627

Specialties & licenses 1

Addresses

Other names 1

• Savannah Smiles Youth Dentistry Doing business as

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476230400000",
    "number": "1497205637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 CHURCH ST",
            "address_2": "SUITE 2210",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372192310",
            "telephone_number": "615-988-2826",
            "fax_number": "631-857-7860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2127 E VICTORY DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314043917",
            "telephone_number": "912-443-6013",
            "fax_number": "912-443-6014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VICTORY DRIVE DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-10-12",
        "status": "A",
        "authorized_official_last_name": "ELKIN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT AND OWNER",
        "authorized_official_telephone_number": "615-988-2627",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Savannah Smiles Youth Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Savannah, GA
• Providers in Savannah, 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 Oct 12, 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.