Professional Dental Alliance of Atlanta Boulevard SE, LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF ATLANTA BOULEVARD SE, LLC

Practice address

465 Boulevard SE Ste 207a
Atlanta, GA 30312-3483

Phone

(404) 624-1230

NPI assigned

May 6, 2019

Organization subpart

No

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

Authorized official

Name

Lauren Howard, MA

Title

Credentialing Specialist

Phone

(724) 698-2029

Specialties & licenses 1

Addresses

Practitioners 2

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

• Joelle Goggans, D.D.S

  • General Practice Dentistry
  • Atlanta, GA
  • NPI 1477907707
  NPD (past)
• Zelda Marie Pittman, DDS

  • Dentist
  • Atlanta, GA
  • NPI 1497858716
  NPD (past)

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

{
    "created_epoch": "1557100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557100800000",
    "number": "1689239675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 BOULEVARD SE STE 207A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303123483",
            "telephone_number": "404-624-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF ATLANTA BOULEVARD SE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-06",
        "last_updated": "2019-05-06",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "724-698-2029",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keishaun Saschier Proctor, M.D.
• Kennedi Proctor, RBT
• Prodigy Therapeutic Solutions LLC
• Professional Care, Inc.
• Professional Counseling Center of Atlanta, LLC
• Professional Medical & Rehab Clinic
• Professional Portable Radiologic Services, Inc. (Professional Portable X-ray)
• Professional Speech & Language Therapy, Inc
• Professional Therapy Providers, Inc
• Progress Counseling and Consulting LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2019; 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.