Active NPI
Ben Mibab, DDS MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Johns Creek, GA
National Provider Identifier
1538236708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- GA 10500
- Practice address
- 3005 Old Alabama Rd
Suite 6000
Johns Creek, GA 30022-8594 - Phone
- (770) 552-6800
- NPI assigned
- Nov 30, 2006
- Last updated
- Feb 16, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | GA 10500 | GA | Primary |
Addresses
Primary practice location
3005 Old Alabama Rd
Suite 6000
Johns Creek, GA 30022-8594
Mailing address
3005 Old Alabama Rd
Suite 6000
Johns Creek, GA 30022-8594
Phone (770) 552-6800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GA 10500 | GA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455580800000",
"number": "1538236708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3005 OLD ALABAMA RD",
"address_2": "SUITE 6000",
"city": "JOHNS CREEK",
"state": "GA",
"postal_code": "300228594",
"telephone_number": "770-552-6800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3005 OLD ALABAMA RD",
"address_2": "SUITE 6000",
"city": "JOHNS CREEK",
"state": "GA",
"postal_code": "300228594",
"telephone_number": "770-552-6800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIBAB",
"first_name": "BEN",
"name_prefix": "Dr.",
"credential": "DDS MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2016-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "GA",
"license": "GA 10500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johns Creek, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 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.