NPIMap

Organization Active NPI

Old Milton Dental

  • Dentist
  • Alpharetta, GA
National Provider Identifier
1508085671
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
012287 Issued in GA
Legal business name
OLD MILTON DENTAL
Practice address
4165 Old Milton Pkwy
Suite 190
Alpharetta, GA 30005-4468
Phone
(678) 624-0370
Fax
(678) 624-0319
NPI assigned
Apr 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Corey J Mazer, DDSNPI 1902919509
Title
Owner
Phone
(678) 624-0370

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 012287 GA Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 012301 GA

Addresses

Primary practice location

4165 Old Milton Pkwy
Suite 190
Alpharetta, GA 30005-4468

Mailing address

4165 Old Milton Pkwy
Suite 190
Alpharetta, GA 30005-4468
Phone (678) 624-0370

National Provider Directory

National Provider Directory

Locations

4165 Old Milton Pkwy
Ste 190
Alpharetta, GA 30005
Phone (678) 624-0370

Practitioners & affiliated clinicians

Practitioners 2

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": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508085671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4165 OLD MILTON PKWY",
            "address_2": "SUITE 190",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300054468",
            "telephone_number": "678-624-0370",
            "fax_number": "678-624-0319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4165 OLD MILTON PKWY",
            "address_2": "SUITE 190",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300054468",
            "telephone_number": "678-624-0370",
            "fax_number": "678-624-0319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD MILTON DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAZER",
        "authorized_official_first_name": "COREY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-624-0370",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "012287",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "012301",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.