Stone Mountain Dental 2, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

STONE MOUNTAIN DENTAL 2, PC

Practice address

3100 Five Forks Trickum Rd SW Ste 402
Lilburn, GA 30047-1887

Phone

(770) 837-9832

Fax

(404) 445-8499

NPI assigned

Sep 18, 2019

Organization subpart

No

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

Authorized official

Name

Ms. Nikki Rolls

Title

Practice Administrator

Phone

(404) 452-1164

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568764800000",
    "number": "1548810997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 FIVE FORKS TRICKUM RD SW STE 402",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300471887",
            "telephone_number": "770-837-9832",
            "fax_number": "404-445-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 FIVE FORKS TRICKUM RD SW STE 402",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300471887",
            "telephone_number": "770-837-9832",
            "fax_number": "404-445-8499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONE MOUNTAIN DENTAL 2, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-18",
        "last_updated": "2019-09-18",
        "status": "A",
        "authorized_official_last_name": "ROLLS",
        "authorized_official_first_name": "NIKKI",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "404-452-1164",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Qiana Stanford
• Faith Ellen Stanley, RBT
• Amanda Jean Moretz Starr, LMT
• Irene Stephanopoulos, FNP-C
• Leigh Katherine Stewart, MS, CCC-SLP
• Paris Street Jr., RPH
• Tracy Lynn Stroud, RPH
• Hye Jung Regina Suk, DMD
• Jessica Daniela Sullivan, MS, CRC, NCC
• Sultana Faiyaz Corporation, LLC

• General Practice Dentistry in Lilburn, GA
• Providers in Lilburn, 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 Sep 18, 2019; 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.