Kirk A Sudeall

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

011931 Issued in GA

Practice address

140 Marble Mill Rd NW Ste B
Marietta, GA 30060-1000

Phone

(770) 590-9848

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Forest Park Denture Center

  • Dental Clinic/Center
  • Forest Park, GA
  • NPI 1811714033
  NPD Authorized official

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770636011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4460 RIDERS RIDGE TRL",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300398580",
            "telephone_number": "770-978-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 MARBLE MILL RD NW STE B",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601000",
            "telephone_number": "770-590-9848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDEALL",
        "first_name": "KIRK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "011931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roger Su, MD
• Kavita Joshi Subrahmanian, PH.D.
• Tarun Jayant Subrahmanian, MD.
• Ramprasad Subramaniam, M.D.
• Lindzy Taylor Suchomelly, PA-C
• Selina Suliveres, DC
• Kristi Spence Sullivan, LCSW
• Thea Delora Sullivan, RN
• Virginia Sullivan, NP-C
• Seth Summers, RBT

• General Practice Dentistry in Marietta, GA
• Providers in Marietta, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.