NPIMap

Organization Active NPI

Peachtree Children's Dentistry

  • Pediatric Dentistry
  • Duluth, GA
National Provider Identifier
1770754772
Registry record updated Jun 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DNO12595 Issued in GA
Legal business name
PEACHTREE CHILDREN'S DENTISTRY
Practice address
3820 Pleasant Hill Rd, Suite 1
Duluth, GA 30096
Phone
(770) 497-0110
Fax
(770) 497-0580
NPI assigned
Mar 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2019

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

Authorized official

Name
Nameun Nancy Kil, DDSNPI 1912944562
Title
Doctor/Business Owner
Phone
(770) 497-0110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X DNO12595 GA Primary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X DNO12519 GA

Addresses

Primary practice location

3820 Pleasant Hill Rd, Suite 1
Duluth, GA 30096

Mailing address

3820 Pleasant Hill Rd, Suite 1
Duluth, GA 30096
Phone (770) 497-0110

Other identifiers 2

IdentifierTypeStateIssuer
000949616BMedicaidGA
000947944BMedicaidGA

National Provider Directory

National Provider Directory

Locations

3820 Pleasant Hill Rd
Ste 1
Duluth, GA 30096
Phone (770) 497-0110

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1205798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560470400000",
    "number": "1770754772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3820 PLEASANT HILL RD, SUITE 1",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "30096",
            "telephone_number": "770-497-0110",
            "fax_number": "770-497-0580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3820 PLEASANT HILL RD, SUITE 1",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "30096",
            "telephone_number": "770-497-0110",
            "fax_number": "770-497-0580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE CHILDREN'S DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-18",
        "last_updated": "2019-06-14",
        "status": "A",
        "authorized_official_last_name": "KIL",
        "authorized_official_first_name": "NAMEUN",
        "authorized_official_middle_name": "NANCY",
        "authorized_official_title_or_position": "DOCTOR/BUSINESS OWNER",
        "authorized_official_telephone_number": "770-497-0110",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DNO12595",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DNO12519",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000949616B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000947944B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; 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.