Kellie Smith Castro Dentistry LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015357 Issued in GA

Legal business name

KELLIE SMITH CASTRO DENTISTRY LLC

Doing business as

Dentistry At The Mills

Practice address

1860 Duluth Hwy Ste 401
Lawrenceville, GA 30043-5061

Phone

(678) 226-9063

Fax

(678) 226-9445

NPI assigned

Oct 30, 2017

Last updated

Oct 30, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kellie Castro, DMD

Title

Owner/Dentist

Phone

(678) 226-9063

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dentistry At The Mills Doing business as

Locations

Practitioners 1

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.

• Kellie Denia Smith-Castro, DMD

  • Dentist
  • Lawrenceville, GA
  • NPI 1619289246

  General Practice

  NPD (past)

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

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509321600000",
    "number": "1730691874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 DULUTH HWY STE 401",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 DULUTH HWY STE 401",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435061",
            "telephone_number": "678-226-9063",
            "fax_number": "678-226-9445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLIE SMITH CASTRO DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-30",
        "last_updated": "2017-10-30",
        "status": "A",
        "authorized_official_last_name": "CASTRO",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "678-226-9063",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "1619289246",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentistry At The Mills",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Joan Irene Kelley, RN
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• Amanda L Kembel, CRNA
• Shelby Kemp, DC
• Kaylee Kennedy, OTD, OTR

• General Practice Dentistry in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; 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.