Orthogenesis, LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

ORTHOGENESIS, LLC

Doing business as

Bloom Orthodontics

Practice address

3005 Royal Blvd S
Suite 200
Alpharetta, GA 30022-1409

Phone

(770) 680-2335

Fax

(678) 550-3046

NPI assigned

Dec 29, 2014

Organization subpart

No

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

Authorized official

Name

Amanda Bullock

Title

Practice Manager

Phone

(770) 680-2335

Specialties & licenses 1

Addresses

Other names 1

• Bloom Orthodontics Doing business as

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.

• Michelle Renee Mathieson, DMD, MSD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Alpharetta, GA
  • NPI 1447510284
  NPD (past)

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

{
    "created_epoch": "1419811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419811200000",
    "number": "1518355577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3005 ROYAL BLVD S",
            "address_2": "SUITE 200",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300221409",
            "telephone_number": "770-680-2335",
            "fax_number": "678-550-3046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3005 ROYAL BLVD S",
            "address_2": "SUITE 200",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300221409",
            "telephone_number": "770-680-2335",
            "fax_number": "678-550-3046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOGENESIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-29",
        "last_updated": "2014-12-29",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "770-680-2335"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloom Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Orcutt, PA-C
• NA'Talia Kiara Orebeau
• Thomas Lawrence Orourke, MD
• Arlene Orozco
• Orthobridge, LLC (Brooks Orthodontic Studio)
• Orthopaedic Specialties of Atlanta, Inc. (Georgia Brace & Spine)
• Orthoscript Inc
• Orthosquad LLC
• Orthotripsy Services of Metroplex
• Valerie Ortiz-Castellanos

• Orthodontics and Dentofacial Orthopedics Dentistry in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2014; 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.