Active NPI
Sarita M Henry, DDS
- Pediatric Dentistry
- Conyers, GA
National Provider Identifier
1770799074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN012241
- Practice address
- 1217 Royal Dr
Ste 262
Conyers, GA 30094 - Phone
- (770) 922-6655
- Fax
- (770) 388-0521
- NPI assigned
- May 15, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN012241 | GA | Primary |
Addresses
Primary practice location
1217 Royal Dr
Ste 262
Conyers, GA 30094
Mailing address
1217 Royal Dr
Conyers, GA 30094
Phone (770) 922-6655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000900974A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN012241 | GA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lester Dental Group LLC | Past | Accepting new patients | |
| Just Kids Dentistry | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pediatric Dentistry
- Snellville, GA
- NPI 1396974051
-
- General Practice Dentistry
- Conyers, GA
- NPI 1659440311
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264118400000",
"number": "1770799074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1217 ROYAL DR",
"city": "CONYERS",
"state": "GA",
"postal_code": "30094",
"telephone_number": "770-922-6655",
"fax_number": "770-388-0521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1217 ROYAL DR",
"address_2": "STE 262",
"city": "CONYERS",
"state": "GA",
"postal_code": "30094",
"telephone_number": "770-922-6655",
"fax_number": "770-388-0521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRY",
"first_name": "SARITA",
"middle_name": "M",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2010-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "GA",
"license": "DN012241",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000900974A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.