Active NPI
Judge, Lisa Maria DDS PC
- General Practice Dentistry
- Marietta, GA
National Provider Identifier
1811040728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN011180
- Legal business name
- JUDGE, LISA MARIA DDS PC
- Practice address
- 1230 Powers Ferry Rd SE
Suite #6
Marietta, GA 30067-5495 - Phone
- (770) 541-0101
- Fax
- (770) 541-0102
- NPI assigned
- Jan 22, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lisa M Judge, D.D.S.
- Title
- Doctor Owner
- Phone
- (770) 541-0101
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN011180 | GA | Primary |
| General Practice Dentistry | 1223G0001X | 4430 | LA |
Addresses
Primary practice location
1230 Powers Ferry Rd SE
Suite #6
Marietta, GA 30067-5495
Mailing address
1230 Powers Ferry Rd SE
Suite #6
Marietta, GA 30067-5495
Phone (770) 541-0101
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00764112B | Medicaid | GA |
National Provider Directory
National Provider DirectoryLocations
1230 Powers Ferry Rd SE
Ste 6
Marietta, GA 30067
Phone (770) 541-0101
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1213574400000",
"number": "1811040728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1230 POWERS FERRY RD SE",
"address_2": "SUITE #6",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300675495",
"telephone_number": "770-541-0101",
"fax_number": "770-541-0102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1230 POWERS FERRY RD SE",
"address_2": "SUITE #6",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300675495",
"telephone_number": "770-541-0101",
"fax_number": "770-541-0102"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JUDGE, LISA MARIA DDS PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-22",
"last_updated": "2008-06-16",
"status": "A",
"authorized_official_last_name": "JUDGE",
"authorized_official_first_name": "LISA",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "DOCTOR OWNER",
"authorized_official_telephone_number": "770-541-0101",
"authorized_official_credential": "D.D.S."
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN011180",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "4430",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00764112B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.