Smith Dental Care of Winder LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SMITH DENTAL CARE OF WINDER LLC

Doing business as

Smith Dental Care of Winder LLC

Practice address

48 Piedmont Dr Ste 302
Winder, GA 30680-8132

Phone

(706) 619-1307

Fax

(706) 510-2594

NPI assigned

Dec 29, 2020

Organization subpart

No

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

Authorized official

Name

Celeste Johnson

Title

Credentialing Specialist

Phone

(706) 376-2345

Specialties & licenses 1

Addresses

Other names 1

• Smith Dental Care of Winder LLC Doing business as

Locations

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

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609200000000",
    "number": "1750978359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 ATLANTA HWY STE 10",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306067201",
            "telephone_number": "706-619-1307",
            "fax_number": "706-510-2594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 PIEDMONT DR STE 302",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306808132",
            "telephone_number": "706-619-1307",
            "fax_number": "706-510-2594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMITH DENTAL CARE OF WINDER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-29",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CELESTE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "706-376-2345"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smith Dental Care of Winder LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Selena Shipp
• Walker Thomas Shoaf III, M.D.
• Derrick Eugene Sims, MD
• Deberah Lee Slade, LCSW
• Courtney M Slaughter, NP
• Amy Smith
• Jeralyn S Smith, M.D.
• John Christy Snyder, O.D.
• Darrell Allen Sorah Jr., OD
• Joseph C Souther, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; 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.