Michelle Gwyn DDS, PC

Primary specialty

DentistTaxonomy code 122300000X

License

DN013195 Issued in GA

Legal business name

MICHELLE GWYN DDS, PC

Doing business as

Perfect Portrait Family Dentistry

Practice address

5040 Bill Gardner Pkwy Ste 300
Locust Grove, GA 30248-3758

Phone

(678) 304-8408

Fax

(689) 304-8409

NPI assigned

Nov 29, 2016

Last updated

Nov 29, 2016By 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

Dr. Michelle Sandra Gwyn, DDS

Title

Owner

Phone

(678) 304-8408

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Perfect Portrait Family Dentistry Doing business as

Locations

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

{
    "created_epoch": "1480377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1740723311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5040 BILL GARDNER PKWY STE 300",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483758",
            "telephone_number": "678-304-8408",
            "fax_number": "689-304-8409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5040 BILL GARDNER PKWY STE 300",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483758",
            "telephone_number": "678-304-8408",
            "fax_number": "689-304-8409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHELLE GWYN DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-29",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "GWYN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "SANDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-304-8408",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN013195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "675686848C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Perfect Portrait Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Locust Grove, GA
• Providers in Locust Grove, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; 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.