NPIMap

Organization Active NPI

Marietta Dental Associates.Inc

  • General Practice Dentistry
  • Marietta, GA
National Provider Identifier
1700095486
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MARIETTA DENTAL ASSOCIATES.INC
Practice address
644 Cherokee St NE
Marietta, GA 30060-8910
Phone
(770) 424-6569
NPI assigned
May 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Earl Adkisson Jr.
Title
President
Phone
(770) 424-6569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

644 Cherokee St NE
Marietta, GA 30060-8910

Mailing address

644 Cherokee St NE
Marietta, GA 30060-8910

National Provider Directory

National Provider Directory

Locations

644 Cherokee St NE
Marietta, GA 30060
Phone (770) 356-0305

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": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700095486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 CHEROKEE ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 CHEROKEE ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608910",
            "telephone_number": "770-424-6569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA DENTAL ASSOCIATES.INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ADKISSON",
        "authorized_official_first_name": "EARL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-424-6569",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.