NPIMap

Organization Active NPI

Kimberly G Redick DMD Family and Cosmetic Dentistry PC

  • General Practice Dentistry
  • Rincon, GA
National Provider Identifier
1730397340
Registry record updated Aug 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN012371 Issued in GA
Legal business name
KIMBERLY G REDICK DMD FAMILY AND COSMETIC DENTISTRY PC
Practice address
131 Silverwood Commercial Dr
Suite #400
Rincon, GA 31326-5131
Phone
(912) 826-1905
NPI assigned
May 18, 2007
Last updated
Aug 23, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2012

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

Authorized official

Name
Kimberly Gail Redick, DMDNPI 1598801995
Title
Dentist,Owner
Phone
(912) 826-1905

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 DN012371 GA Primary

Addresses

Primary practice location

131 Silverwood Commercial Dr
Suite #400
Rincon, GA 31326-5131

Mailing address

PO Box 2406
Rincon, GA 31326-2406
Phone (912) 826-1905

Other identifiers 1

IdentifierTypeStateIssuer
1813935OtherGAUNITED CONCORDIA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345680000000",
    "number": "1730397340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2406",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313262406",
            "telephone_number": "912-826-1905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 SILVERWOOD COMMERCIAL DR",
            "address_2": "SUITE #400",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313265131",
            "telephone_number": "912-826-1905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY G REDICK DMD FAMILY AND COSMETIC DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2012-08-23",
        "status": "A",
        "authorized_official_last_name": "REDICK",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "GAIL",
        "authorized_official_title_or_position": "DENTIST,OWNER",
        "authorized_official_telephone_number": "912-826-1905",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1813935",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rincon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2012; 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.