NPIMap

Organization Active NPI

Royal Lakes Family and Cosmetic Dentistry, LLC

  • General Practice Dentistry
  • Flowery Branch, GA
National Provider Identifier
1710216783
Registry record updated Dec 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN013464 Issued in GA
Legal business name
ROYAL LAKES FAMILY AND COSMETIC DENTISTRY, LLC
Practice address
4005 Winder Hwy
Suite 100
Flowery Branch, GA 30542-6564
Phone
(770) 531-3232
Fax
(770) 531-3238
NPI assigned
Dec 21, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2009

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

Authorized official

Name
Dr. Reginald Douglas Booker, DDSNPI 1699711416
Title
Owner/Dentist
Phone
(770) 531-3232

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN013464 GA Primary

Addresses

Primary practice location

4005 Winder Hwy
Suite 100
Flowery Branch, GA 30542-6564

Mailing address

4005 Winder Hwy
Suite 100
Flowery Branch, GA 30542-6564
Phone (770) 531-3232

Other identifiers 1

IdentifierTypeStateIssuer
1699711416OtherGAINDIVIDUAL NPI NUMBER

National Provider Directory

National Provider Directory

Locations

4005 Winder Hwy
Ste 100
Flowery Branch, GA 30542
Phone (770) 531-3232

Practitioners & affiliated clinicians

Practitioners 1

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": "1261353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261353600000",
    "number": "1710216783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 WINDER HWY",
            "address_2": "SUITE 100",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305426564",
            "telephone_number": "770-531-3232",
            "fax_number": "770-531-3238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 WINDER HWY",
            "address_2": "SUITE 100",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305426564",
            "telephone_number": "770-531-3232",
            "fax_number": "770-531-3238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROYAL LAKES FAMILY AND COSMETIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-21",
        "last_updated": "2009-12-21",
        "status": "A",
        "authorized_official_last_name": "BOOKER",
        "authorized_official_first_name": "REGINALD",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "770-531-3232",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1699711416",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowery Branch, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2009; 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.