NPIMap

Organization Active NPI

Muccioli Dental, PC

  • General Practice Dentistry
  • Johns Creek, GA
National Provider Identifier
1558796896
Registry record updated Sep 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN014378 Issued in GA
Legal business name
MUCCIOLI DENTAL, PC
Practice address
6300 Hospital Pkwy
Suite 275
Johns Creek, GA 30097-1828
Phone
(678) 389-9955
Fax
(678) 389-9952
NPI assigned
Sep 5, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2013

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

Authorized official

Name
Dr. Randy Earl Muccioli, D.M.DNPI 1346229614
Title
Owner/Dentist
Phone
(678) 389-9955

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
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DN014378 GA Primary
ProsthodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0700X DN014379 GA

Addresses

Primary practice location

6300 Hospital Pkwy
Suite 275
Johns Creek, GA 30097-1828

Mailing address

6300 Hospital Pkwy
Suite 275
Johns Creek, GA 30097-1828
Phone (678) 389-9955

National Provider Directory

National Provider Directory

Locations

6300 Hospital Pkwy
Ste 275
Johns Creek, GA 30097
Phone (678) 389-9955

Practitioners & affiliated clinicians

Practitioners 1

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": "1378339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378339200000",
    "number": "1558796896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 HOSPITAL PKWY",
            "address_2": "SUITE 275",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971828",
            "telephone_number": "678-389-9955",
            "fax_number": "678-389-9952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 HOSPITAL PKWY",
            "address_2": "SUITE 275",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300971828",
            "telephone_number": "678-389-9955",
            "fax_number": "678-389-9952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUCCIOLI DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-05",
        "last_updated": "2013-09-05",
        "status": "A",
        "authorized_official_last_name": "MUCCIOLI",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "678-389-9955",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN014378",
            "primary": true
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "GA",
            "license": "DN014379",
            "primary": false
        }
    ],
    "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 Sep 5, 2013; 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.