East Atlanta Pediatric Dentistry PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN012645 Issued in GA

Legal business name

EAST ATLANTA PEDIATRIC DENTISTRY PC

Practice address

2646 Gresham Rd SE
Atlanta, GA 30316-4148

Phone

(404) 243-0929

Fax

(404) 243-0928

NPI assigned

Dec 17, 2014

Organization subpart

No

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

Authorized official

Name

Teresa Jordan, DMDNPI 1780888693

Title

Dentist/Owner

Phone

(404) 243-0929

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Teresa Danielle Jordan, DMD

  • Pediatric Dentistry
  • Atlanta, GA
  • NPI 1780888693
  NPD (past) Authorized official

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

{
    "created_epoch": "1418774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418774400000",
    "number": "1740688142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2646 GRESHAM RD SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303164148",
            "telephone_number": "404-243-0929",
            "fax_number": "404-243-0928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2646 GRESHAM RD SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303164148",
            "telephone_number": "404-243-0929",
            "fax_number": "404-243-0928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST ATLANTA PEDIATRIC DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-17",
        "last_updated": "2014-12-17",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "404-243-0929",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN012645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1780888693",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "DN012645",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ease Wellness Chiropractic
• Kimberly L Eason, WHNP
• Elaine Eassa, PH.D.
• East Atlanta Injury and Wellness
• East Atlanta Oral, Implant and Facial Surgery Center
• East Coast Plastic Surgery of Georgia LLC
• East Mid Medical Supply and Courier LLC
• Angela East, CPNP
• Easter Seals North Georgia, Inc.
• Sidney Adair Easterling, PA

• Pediatric Dentistry in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; 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.