South Hairston Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10982 Issued in GA

Legal business name

SOUTH HAIRSTON FAMILY DENTISTRY

Practice address

1234 S Hairston Rd
Suite 23
Stone Mountain, GA 30088-2749

Phone

(404) 294-3600

NPI assigned

Jan 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Heather Allen, D.D.S.NPI 1073608410

Title

Dentist

Phone

(404) 294-3600

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather Allen, D.D.S.

  • General Practice Dentistry
  • Stone Mountain, GA
  • NPI 1073608410
  NPD (past) Authorized official

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221609600000",
    "number": "1598817488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 S HAIRSTON RD",
            "address_2": "SUITE 23",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300882749",
            "telephone_number": "404-294-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 S HAIRSTON RD",
            "address_2": "SUITE 23",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300882749",
            "telephone_number": "404-294-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH HAIRSTON FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2008-09-17",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "404-294-3600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "10982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00581215A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Stone Mountain, GA
• Providers in Stone Mountain, 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 17, 2008; 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.