NPIMap

Organization Active NPI

Northwest Endodontic Specialists, P.C.

  • Endodontics
  • Woodstock, GA
National Provider Identifier
1801916069
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
10232, 10416 Issued in GA
Legal business name
NORTHWEST ENDODONTIC SPECIALISTS, P.C.
Practice address
271 Heritage Walk
Woodstock, GA 30188-3876
Phone
(770) 924-0423
Fax
(770) 924-9222
NPI assigned
Mar 30, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Richardson Michael Odum, D.M.D.NPI 1962522110
Title
President
Phone
(770) 924-0423

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 10232, 10416 GA Primary

Addresses

Primary practice location

271 Heritage Walk
Woodstock, GA 30188-3876

Mailing address

271 Heritage Walk
Woodstock, GA 30188-3876
Phone (770) 924-0423

National Provider Directory

National Provider Directory
Tax ID family
Canton Office2 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

271 Heritage Walk
Woodstock, GA 30188
Phone (770) 924-0423

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": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801916069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 HERITAGE WALK",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301883876",
            "telephone_number": "770-924-0423",
            "fax_number": "770-924-9222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 HERITAGE WALK",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301883876",
            "telephone_number": "770-924-0423",
            "fax_number": "770-924-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST ENDODONTIC SPECIALISTS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ODUM",
        "authorized_official_first_name": "RICHARDSON",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-924-0423",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "GA",
            "license": "10232, 10416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; 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.