NPIMap

Organization Active NPI

Heartland Dental Care of Georgia, P.C.

Doing business as Little River Family Dental

  • General Practice Dentistry
  • Woodstock, GA
National Provider Identifier
1790190056
Registry record updated Jun 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
HEARTLAND DENTAL CARE OF GEORGIA, P.C.
Doing business as
Little River Family Dental
Practice address
12201 Highway 92
Suite G/H
Woodstock, GA 30188-7140
Phone
(678) 348-6858
NPI assigned
Jun 25, 2014
Last updated
Jun 25, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
HEARTLAND DENTAL CARE OF GEORGIA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 25, 2014

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

Authorized official

Name
Kendra Walker
Title
Credentialing Coordinator
Phone
(217) 540-8312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

12201 Highway 92
Suite G/H
Woodstock, GA 30188-7140

Mailing address

12201 Highway 92
Suite G/H
Woodstock, GA 30188-7140

Other names 1

  • Little River Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Georgia Dental Professionals PC72 organizations share this tax ID, including this one
Part of
Georgia Dental Professionals PC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

12201 Highway 92
Ste Gh
Woodstock, GA 30188
Phone (678) 348-6858

Practitioners & affiliated clinicians

Practitioners 3

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": "1403654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403654400000",
    "number": "1790190056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12201 HIGHWAY 92",
            "address_2": "SUITE G/H",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301887140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12201 HIGHWAY 92",
            "address_2": "SUITE G/H",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301887140",
            "telephone_number": "678-348-6858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND DENTAL CARE OF GEORGIA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEARTLAND DENTAL CARE OF GEORGIA, P.C.",
        "enumeration_date": "2014-06-25",
        "last_updated": "2014-06-25",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8312"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little River Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodstock, GA

Sources for this page

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