Peachtree Dunwoody Oral and Facial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN010345 Issued in GA

Legal business name

PEACHTREE DUNWOODY ORAL AND FACIAL SURGERY

Practice address

5505 Peachtree Dunwoody Rd
Suite 660
Atlanta, GA 30342-1705

Phone

(404) 220-7505

Fax

(404) 220-7506

NPI assigned

Dec 8, 2014

Last updated

Dec 8, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Irene Iverson

Title

Insurance Administrator

Phone

(404) 220-7505

Specialties & licenses 1

Addresses

Tax ID family

Peachtree Dunwoody Oral and Facial Surgery2 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.

• Peachtree Dunwoody Oral and Facial Surgery, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Atlanta, GA
  • NPI 1639542459
  NPD tax ID

Locations

Practitioners 5

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.

• Hari Kiran Digumarthi, DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Atlanta, GA
  • NPI 1821291816
  NPD (past)
• Simweray S. Kawalie-Fataki

  • Dental Assistant
  • Atlanta, GA
  • NPI 1437063591
  NPD (past)
• Amy Diane Kuhmichel, D.M.D

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Atlanta, GA
  • NPI 1083889661

  Oral and Maxillofacial Surgery

  NPD (past)
• Glenn Maron, DDS FACS

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Atlanta, GA
  • NPI 1295791549
  NPD (past)
• Shenan Marie Bradshaw, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Chesterfield, MO
  • NPI 1699040121
  NPD (past)

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

{
    "created_epoch": "1417996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417996800000",
    "number": "1770981763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5505 PEACHTREE DUNWOODY RD",
            "address_2": "SUITE 660",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421705",
            "telephone_number": "404-220-7505",
            "fax_number": "404-220-7506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 PEACHTREE DUNWOODY RD",
            "address_2": "SUITE 660",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421705",
            "telephone_number": "404-220-7505",
            "fax_number": "404-220-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE DUNWOODY ORAL AND FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-08",
        "last_updated": "2014-12-08",
        "status": "A",
        "authorized_official_last_name": "IVERSON",
        "authorized_official_first_name": "IRENE",
        "authorized_official_title_or_position": "INSURANCE ADMINISTRATOR",
        "authorized_official_telephone_number": "404-220-7505",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN010345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peachtree Center Rehab LLC
• Peachtree Center Rehab Medical Services
• Peachtree Colon and Rectal Clinic
• Peachtree Creative Counseling
• Peachtree Dermatology Associates, PC
• Peachtree Dunwoody Oral and Facial Surgery, PC
• Peachtree Ear, Nose & Throat Center, LLC
• Peachtree Emergency Associates
• Peachtree Emergency Physicians LLC
• Peachtree Eye Associates P C

• Oral and Maxillofacial Surgery (Dentist) in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.