NPIMap

Organization Active NPI

Pine Mountain Family Dentistry, LLC

  • Dentist
  • Pine Mountain, GA
National Provider Identifier
1780915165
Registry record updated Jan 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DNO12733 Issued in GA
Legal business name
PINE MOUNTAIN FAMILY DENTISTRY, LLC
Practice address
8944 Hamilton Road
Pine Mountain, GA 31822
Phone
(706) 663-2272
Fax
(706) 663-2075
NPI assigned
Jan 25, 2010
Last updated
Jan 25, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2010

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

Authorized official

Name
Dr. Sidney Dauster Harden III, D.M.D.NPI 1851515704
Title
Dentist
Phone
(706) 663-2272

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
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DNO12733 GA Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DNO08005 GA

Addresses

Primary practice location

8944 Hamilton Road
Pine Mountain, GA 31822

Mailing address

P.O. Box 1176
Pine Mountain, GA 31822-4707
Phone (706) 663-2272

Other identifiers 2

IdentifierTypeStateIssuer
000045295AMedicaidGA
594312970BMedicaidGA

National Provider Directory

National Provider Directory

Locations

8944 Hamilton Rd
Pine Mountain, GA 31822
Phone (706) 663-2272

Practitioners & affiliated clinicians

Practitioners 4

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": "1264377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264377600000",
    "number": "1780915165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1176",
            "city": "PINE MOUNTAIN",
            "state": "GA",
            "postal_code": "318224707",
            "telephone_number": "706-663-2272",
            "fax_number": "706-663-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8944 HAMILTON ROAD",
            "city": "PINE MOUNTAIN",
            "state": "GA",
            "postal_code": "31822",
            "telephone_number": "706-663-2272",
            "fax_number": "706-663-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE MOUNTAIN FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-25",
        "last_updated": "2010-01-25",
        "status": "A",
        "authorized_official_last_name": "HARDEN",
        "authorized_official_first_name": "SIDNEY",
        "authorized_official_middle_name": "DAUSTER",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "706-663-2272",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DNO12733",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DNO08005",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000045295A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "594312970B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Mountain, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.

Verify at the official NPI Registry.