Spectrum Dental Care

Primary specialty

DentistTaxonomy code 122300000X

License

012240 Issued in GA

Legal business name

SPECTRUM DENTAL CARE

Practice address

6270 Smithpointe Dr
Norcross, GA 30092-2754

Phone

(770) 263-8408

Fax

(770) 263-8744

NPI assigned

Sep 16, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Ifeanyi Ezunu N, DDS

Title

Doctor

Phone

(770) 263-8408

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442361600000",
    "number": "1679942049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6270 SMITHPOINTE DR",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300922754",
            "telephone_number": "770-263-8408",
            "fax_number": "770-263-8744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6270 SMITHPOINTE DR",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300922754",
            "telephone_number": "770-263-8408",
            "fax_number": "770-263-8744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-16",
        "last_updated": "2015-09-16",
        "status": "A",
        "authorized_official_last_name": "N",
        "authorized_official_first_name": "IFEANYI",
        "authorized_official_middle_name": "EZUNU",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "770-263-8408",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "012240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000972694A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; 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.