NPIMap

Organization Active NPI

Westside Management

  • Dentist
  • Marietta, GA
National Provider Identifier
1770970915
Registry record updated Apr 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
71012 Issued in GA
Legal business name
WESTSIDE MANAGEMENT
Practice address
3515 Dallas Hwy Ste. B
Marietta, GA 30064
Phone
(770) 499-7005
Fax
(770) 499-7081
NPI assigned
Apr 24, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2015

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

Authorized official

Name
Sherryl Ann Odonnell
Title
MGR
Phone
(770) 499-7005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 71012 GA Primary

Addresses

Primary practice location

3515 Dallas Hwy Ste. B
Marietta, GA 30064

Mailing address

3515 Dallas Hwy Ste. B
Marietta, GA 30064
Phone (770) 499-7005

Other identifiers 1

IdentifierTypeStateIssuer
65978OtherGADELTA DENTAL OF GA.

Other names 1

  • Westside Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Westside Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1429833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429833600000",
    "number": "1770970915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 DALLAS HWY STE. B",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30064",
            "telephone_number": "770-499-7005",
            "fax_number": "770-499-7081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 DALLAS HWY STE. B",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30064",
            "telephone_number": "770-499-7005",
            "fax_number": "770-499-7081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-24",
        "last_updated": "2015-04-24",
        "status": "A",
        "authorized_official_last_name": "ODONNELL",
        "authorized_official_first_name": "SHERRYL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "770-499-7005"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "71012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF GA.",
            "identifier": "65978",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westside Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; 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.