Square One Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DN012307 Issued in GA

Legal business name

SQUARE ONE DENTAL LLC

Practice address

3510 Rowe Lane
Cumming, GA 30041

Phone

(770) 888-8295

NPI assigned

Sep 1, 2016

Organization subpart

No

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

Authorized official

Name

Sengsouriya AnanthasaneNPI 1346238706

Title

Dentist

Phone

(770) 888-8295

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Sengsouriya Ananthasane, DMD

  • Dentist
  • Cumming, GA
  • NPI 1346238706
  NPD (past) Authorized official

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1679029219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5870 CHARLOTTE LN",
            "address_2": "SUITE 200",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300400316",
            "telephone_number": "770-888-8295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 ROWE LANE",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "30041",
            "telephone_number": "770-888-8295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUARE ONE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "ANANTHASANE",
        "authorized_official_first_name": "SENGSOURIYA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "770-888-8295"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "DN012307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Audiya Stanley, BCBA

• Dental Clinic/Center in Cumming, GA
• Providers in Cumming, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.