Theodis Elzie, D.D.S., P.C.

Primary specialty

DentistTaxonomy code 122300000X

License

DN010679 Issued in GA

Legal business name

THEODIS ELZIE, D.D.S., P.C.

Doing business as

Brighten Your Smile Dentistry

Practice address

705 Windy Hill Rd SE
Smyrna, GA 30080-1854

Phone

(770) 808-1641

Fax

(770) 801-0587

NPI assigned

Oct 6, 2010

Last updated

Oct 6, 2010By 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

Theodis Elzie, D.D.S.NPI 1164440095

Title

President

Phone

(770) 801-1641

Specialties & licenses 1

Addresses

Other names 1

• Brighten Your Smile Dentistry Doing business as

Locations

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.

• Theodis Elzie, D.D.S.

  • Dentist
  • Smyrna, GA
  • NPI 1164440095
  NPD (past) Authorized official
• Keith E Shepard, DDS

  • Dentist
  • Smyrna, GA
  • NPI 1386855880
  NPD (past)

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

{
    "created_epoch": "1286323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286323200000",
    "number": "1780993840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 WINDY HILL RD SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300801854",
            "telephone_number": "770-808-1641",
            "fax_number": "770-801-0587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 WINDY HILL RD SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300801854",
            "telephone_number": "770-808-1641",
            "fax_number": "770-801-0587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODIS ELZIE, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-06",
        "last_updated": "2010-10-06",
        "status": "A",
        "authorized_official_last_name": "ELZIE",
        "authorized_official_first_name": "THEODIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-801-1641",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN010679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brighten Your Smile Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Smyrna, GA
• Providers in Smyrna, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.