Great Smiles Buford Center LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

GREAT SMILES BUFORD CENTER LLC

Practice address

1879 Buford Hwy Ste 5a
Buford, GA 30518-3628

Phone

(470) 722-5591

NPI assigned

Mar 27, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Beverly Zidor, DDSNPI 1992144554

Title

Ceo

Phone

(772) 828-9005

Specialties & licenses 1

Addresses

Other names 1

• N/A Other name

Locations

Practitioners 1

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

• Beverly Zidor, DDS

  • General Practice Dentistry
  • Acworth, GA
  • NPI 1992144554
  NPD Authorized official

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

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679875200000",
    "number": "1740984574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2055 BARRETT LAKES BLVD # 822",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301448003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1879 BUFORD HWY STE 5A",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305183628",
            "telephone_number": "470-722-5591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT SMILES BUFORD CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-27",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "ZIDOR",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "772-828-9005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "N/A",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dentist in Buford, GA
• Providers in Buford, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; 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.