Eastlight Dental, L.L.C.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

EASTLIGHT DENTAL, L.L.C.

Practice address

2536 Rockbridge Rd Ste 103
Stone Mountain, GA 30087-3636

Phone

(678) 395-5913

NPI assigned

Aug 6, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Edmund Thomas Jr., DDSNPI 1578979381

Title

Owner

Phone

(716) 949-2183

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.

• Edmund Thomas Jr.

  • Dentist
  • Stone Mountain, GA
  • NPI 1578979381
  NPD (past) Authorized official

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

{
    "created_epoch": "1533513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537228800000",
    "number": "1689152282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2536 ROCKBRIDGE RD STE 103",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873636",
            "telephone_number": "678-395-5913",
            "fax_number": "678-395-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2536 ROCKBRIDGE RD STE 103",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873636",
            "telephone_number": "678-395-5913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLIGHT DENTAL, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-06",
        "last_updated": "2018-09-18",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "EDMUND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-949-2183",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Stone Mountain, GA
• Providers in Stone Mountain, 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 18, 2018; 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.