NPIMap

Organization Active NPI

Creekside Dentistry, LLC

  • General Practice Dentistry
  • Loganville, GA
National Provider Identifier
1558768770
Registry record updated Dec 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
GA8776 Issued in GA
Legal business name
CREEKSIDE DENTISTRY, LLC
Practice address
3238 Krisam Creek Dr
Loganville, GA 30052-7942
Phone
(770) 466-0474
Fax
(770) 466-3894
NPI assigned
Dec 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2014

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

Authorized official

Name
Cyndi Simmons
Title
Practice Manager
Phone
(770) 466-0474

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X GA8776 GA Primary

Addresses

Primary practice location

3238 Krisam Creek Dr
Loganville, GA 30052-7942

Mailing address

3238 Krisam Creek Dr
Loganville, GA 30052-7942
Phone (770) 466-0474

National Provider Directory

National Provider Directory

Locations

3238 Krisam Creek Dr
Loganville, GA 30052
Phone (770) 466-0474

Practitioners & affiliated clinicians

Practitioners 4

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": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1558768770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3238 KRISAM CREEK DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300527942",
            "telephone_number": "770-466-0474",
            "fax_number": "770-466-3894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3238 KRISAM CREEK DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300527942",
            "telephone_number": "770-466-0474",
            "fax_number": "770-466-3894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "CYNDI",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "770-466-0474"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "GA8776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loganville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.