Little Peaches Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN013163 Issued in GA

Legal business name

LITTLE PEACHES PEDIATRIC DENTISTRY

Practice address

120 Handley Rd
Suite 210
Tyrone, GA 30290-2177

Phone

(770) 632-7090

Fax

(770) 632-7075

NPI assigned

Jun 17, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Charisse Caswell, DMDNPI 1326013921

Title

Owner

Phone

(770) 632-7090

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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.

• Charisse L. Caswell, DMD

  • Pediatric Dentistry
  • Tyrone, GA
  • NPI 1326013921
  NPD (past) Authorized official

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

{
    "created_epoch": "1466121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466121600000",
    "number": "1801246079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 HANDLEY RD",
            "address_2": "SUITE 210",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302902177",
            "telephone_number": "770-632-7090",
            "fax_number": "770-632-7075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 HANDLEY RD",
            "address_2": "SUITE 210",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302902177",
            "telephone_number": "770-632-7090",
            "fax_number": "770-632-7075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE PEACHES PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-17",
        "last_updated": "2016-06-17",
        "status": "A",
        "authorized_official_last_name": "CASWELL",
        "authorized_official_first_name": "CHARISSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-632-7090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "773054619H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "773054619G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paulette Lorene Lewis, MPT, DPT
• Paul Washington Lindo, D.D.S.
• Elizabeth Lindsey, OTR/L
• Ticaria Lynne Lipsey, M.D.
• Little Bloomers Pediatric Therapy LLC
• Margaret Locker-Polding
• Sharon Marie Loggins, D.C.
• Lotus Center for Counseling and Wellness LLC
• Asia Lurry, RBT
• Manifested Destiny Counseling

• Pediatric Dentistry in Tyrone, GA
• Providers in Tyrone, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; 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.