NPIMap

Organization Active NPI

Patriots Park Dental

  • General Practice Dentistry
  • Grovetown, GA
National Provider Identifier
1689002610
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PATRIOTS PARK DENTAL
Practice address
2054 Warrior Way
Grovetown, GA 30813-8132
Phone
(706) 664-0744
Fax
(706) 664-0747
NPI assigned
Oct 30, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

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

Authorized official

Name
Thomas Moreno, DDSNPI 1487633756
Title
Owner
Phone
(706) 664-0744

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

2054 Warrior Way
Grovetown, GA 30813-8132

Mailing address

2054 Warrior Way
Grovetown, GA 30813-8132
Phone (706) 664-0744

National Provider Directory

National Provider Directory

Locations

2054 Warrior Way
Grovetown, GA 30813
Phone (706) 664-0744

701 Devika Dr
Ste 10
Grovetown, GA 30813
Phone (706) 664-0744

Practitioners & affiliated clinicians

Practitioners 5

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": "1383091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1689002610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2054 WARRIOR WAY",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308138132",
            "telephone_number": "706-664-0744",
            "fax_number": "706-664-0747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2054 WARRIOR WAY",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308138132",
            "telephone_number": "706-664-0744",
            "fax_number": "706-664-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRIOTS PARK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-30",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-664-0744",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grovetown, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; 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.