NPIMap

Organization Active NPI

Georgia Dental Professionals, PC

Doing business as Olde Mill Family Dental

  • General Practice Dentistry
  • Marietta, GA
National Provider Identifier
1720458177
Registry record updated Nov 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Doing business as
Olde Mill Family Dental
Practice address
3101 Roswell Rd
Suite 164
Marietta, GA 30062-7621
Phone
(678) 310-0330
NPI assigned
Sep 29, 2015
Last updated
Nov 4, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
GEORGIA DENTAL PROFESSIONALS, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2015

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

Authorized official

Name
Kendra Walker
Title
Credentialing Coordinator
Phone
(217) 540-8312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

3101 Roswell Rd
Suite 164
Marietta, GA 30062-7621

Mailing address

3101 Roswell Rd
Suite 164
Marietta, GA 30062-7621
Phone (678) 310-0330

Other names 1

  • Olde Mill Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Georgia Dental Professionals PC72 organizations share this tax ID, including this one
Part of
Georgia Dental Professionals PC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

3101 Roswell Rd
Ste 164
Marietta, GA 30062
Phone (678) 310-0330

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446595200000",
    "number": "1720458177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 ROSWELL RD",
            "address_2": "SUITE 164",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300627621",
            "telephone_number": "678-310-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 ROSWELL RD",
            "address_2": "SUITE 164",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300627621",
            "telephone_number": "678-310-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DENTAL PROFESSIONALS, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA DENTAL PROFESSIONALS, PC",
        "enumeration_date": "2015-09-29",
        "last_updated": "2015-11-04",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8312"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olde Mill Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 4, 2015; 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.