Statesboro Pediatric Dentistry, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

STATESBORO PEDIATRIC DENTISTRY, LLC

Practice address

613 E Grady St
Statesboro, GA 30458-5104

Phone

(478) 456-5907

NPI assigned

Jan 4, 2019

Last updated

Jan 4, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Anjali Puri Patel, DMDNPI 1144543372

Title

Dentist/Owner

Phone

(478) 456-5907

Specialties & licenses 1

Addresses

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.

• Anjali Puri Patel, DMD

  • Dentist
  • Statesboro, GA
  • NPI 1144543372
  Authorized official Same address or phone

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

{
    "created_epoch": "1546560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546560000000",
    "number": "1568935286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 IRONGATE PL",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304589195",
            "telephone_number": "478-456-5907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 E GRADY ST",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585104",
            "telephone_number": "478-456-5907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATESBORO PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-04",
        "last_updated": "2019-01-04",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "ANJALI",
        "authorized_official_middle_name": "PURI",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "478-456-5907",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Statesboro Pathology Associates
• Statesboro Physical Therapy Services Inc
• Statesboro Plastic Surgery
• Statesboro Psychiatric Associates
• Statesboro Trails of Journey LLC
• Statesboro Urologic Clinic, PC

• Pediatric Dentistry in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.