NPIMap

Organization Active NPI

Moon Road Cosmetic & Family Dentistry

  • Dental Clinic/Center
  • Columbus, GA
National Provider Identifier
1790970614
Registry record updated Sep 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
011235 Issued in GA
Legal business name
MOON ROAD COSMETIC & FAMILY DENTISTRY
Practice address
7209 Moon Rd
Columbus, GA 31909-1798
Phone
(706) 243-3000
NPI assigned
Sep 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2007

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

Authorized official

Name
Dayo Obebe, DMD
Title
Director
Phone
(706) 243-3000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 011235 GA
Dental Clinic/Center 261QD0000X 011235 GA Primary

Addresses

Primary practice location

7209 Moon Rd
Columbus, GA 31909-1798

Mailing address

7209 Moon Rd
Columbus, GA 31909-1798
Phone (706) 243-3000

National Provider Directory

National Provider Directory
Tax ID family
Riverchase Dental Care2 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.

Locations

7209 Moon Rd
Columbus, GA 31909
Phone (706) 243-3000

NPI Registry JSON

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1790970614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7209 MOON RD",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319091798",
            "telephone_number": "706-243-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7209 MOON RD",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319091798",
            "telephone_number": "706-243-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOON ROAD COSMETIC & FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-13",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "OBEBE",
        "authorized_official_first_name": "DAYO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "706-243-3000",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "011235",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "011235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; 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.