Palmetto Family Dental of Fayette County, PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PALMETTO FAMILY DENTAL OF FAYETTE COUNTY, PC

Practice address

210 Trilith Pkwy Ste 130
Fayetteville, GA 30214-4615

Phone

(706) 580-9670

NPI assigned

Aug 16, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Jordan Brunson, DDS

Title

President/Owner

Phone

(706) 580-9670

Specialties & licenses 1

Addresses

Tax ID family

Palmetto Family Dental of Fayette County PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Palmetto Sleep, PC

  • Dentist
  • Palmetto, GA
  • NPI 1841121704
  NPD tax ID

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

{
    "created_epoch": "1692144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692144000000",
    "number": "1629851472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 TRILITH PKWY STE 130",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144615",
            "telephone_number": "706-580-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 TRILITH PKWY STE 130",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144615",
            "telephone_number": "706-580-9670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO FAMILY DENTAL OF FAYETTE COUNTY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-16",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A",
        "authorized_official_last_name": "BRUNSON",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "706-580-9670",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tryphena Pacitti, NP
• Donna Page, DOULA
• Manjit Pakkala, MD
• Dawn Leilani Paletta, PA
• Allane J Palmer, CNA
• Palmetto Sleep PC
• Kashif Panjwani, PHARMD
• Diliana K Panova, M.D.
• Jake Parham, OTR/L
• Hana Park

• Dentist in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; 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.