Peach State Dental Implants and Periodontics

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

PEACH STATE DENTAL IMPLANTS AND PERIODONTICS

Doing business as

Peach State Laser Periodontics & Implants

Practice address

4300 Westbrook Rd # F
Suwanee, GA 30024-4987

Phone

(770) 310-7822

NPI assigned

Aug 20, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Malissa Nicole Gianfala

Title

HR/Operations Manager

Phone

(770) 500-8446

Specialties & licenses 1

Addresses

Other names 1

• Peach State Laser Periodontics & Implants Doing business as

Locations

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

{
    "created_epoch": "1629417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629417600000",
    "number": "1740956572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 WESTBROOK RD # F",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244987",
            "telephone_number": "770-310-7822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 WESTBROOK RD # F",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244987",
            "telephone_number": "770-310-7822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH STATE DENTAL IMPLANTS AND PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-20",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "GIANFALA",
        "authorized_official_first_name": "MALISSA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "HR/OPERATIONS MANAGER",
        "authorized_official_telephone_number": "770-500-8446",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peach State Laser Periodontics & Implants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Payne & Payne, PC (South Forsyth/Alpharetta Eyecare)
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• Jo Ann T Payne, OD
• Gary Payton, R. PH.
• Peach Dermatology, P.C.
• Peachtree Medical Clinic LLC
• Peachtree Pediatric Urgent Care, LLC
• Peachtree Spine & Pain Physicians, Inc (Peachtree Spine Physicians, Inc)
• Peachtree Wellness Group LLC (Peachtree Pain and Rehab)
• Samantha Joelle Peacock, PTA

• Periodontics in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Periodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; 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.