NPIMap

Organization Active NPI

Kids Dental, PC

  • Pediatric Dentistry
  • Riverdale, GA
National Provider Identifier
1629190186
Registry record updated Jan 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN012467 Issued in GA
Legal business name
KIDS DENTAL, PC
Practice address
12 Rountree Rd
Riverdale, GA 30274-4036
Phone
(678) 479-7001
Fax
(678) 479-7007
NPI assigned
Apr 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2011

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

Authorized official

Name
Dr. Monica Denise McIntyre, DDSNPI 1457374787
Title
Pediatric Dentist
Phone
(678) 479-7001

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X DN012467 GA Primary

Addresses

Primary practice location

12 Rountree Rd
Riverdale, GA 30274-4036

Mailing address

12 Rountree Rd
Riverdale, GA 30274-4036
Phone (678) 479-7001

National Provider Directory

National Provider Directory

Locations

12 Rountree Rd
Riverdale, GA 30274
Phone (678) 479-7001

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": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296086400000",
    "number": "1629190186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 ROUNTREE RD",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302744036",
            "telephone_number": "678-479-7001",
            "fax_number": "678-479-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 ROUNTREE RD",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302744036",
            "telephone_number": "678-479-7001",
            "fax_number": "678-479-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2011-01-27",
        "status": "A",
        "authorized_official_last_name": "MCINTYRE",
        "authorized_official_first_name": "MONICA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "678-479-7001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN012467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2011; 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.