Mouthpeace Dental 4, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MOUTHPEACE DENTAL 4, LLC

Doing business as

MouthPeace Dental

Practice address

541 Forest Pkwy Ste 18
Forest Park, GA 30297-6110

Phone

(404) 228-6801

NPI assigned

Apr 14, 2020

Last updated

Apr 14, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Syretta Wells, DDSNPI 1184875882

Title

Owner /Dentist

Phone

(312) 371-1423

Specialties & licenses 1

Addresses

Other names 1

• MouthPeace Dental Doing business as

Locations

Practitioners 2

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.

• Syretta Wells, DDS

  • Prosthodontics
  • Forest Park, GA
  • NPI 1184875882
  NPD Authorized official
• Jessica Leonard, DMD

  • Dentist
  • Duluth, GA
  • NPI 1376292995
  NPD (past)

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

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586822400000",
    "number": "1811516479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 BRANNEN RD SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303164117",
            "telephone_number": "312-371-1423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 FOREST PKWY STE 18",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302976110",
            "telephone_number": "404-228-6801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUTHPEACE DENTAL 4, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-14",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "SYRETTA",
        "authorized_official_title_or_position": "OWNER /DENTIST",
        "authorized_official_telephone_number": "312-371-1423",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MouthPeace Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daliannys Morales Mendez, M.D.
• Clarence E Morgan Jr., M.D.
• Natascha Mosley
• Denise Moten, DPT
• Motion PT Group Georgia LLC
• Patricia Newton, RN
• Mary Nguyen
• Thu Thao Nguyen, PHARMD
• Rena Norman
• Oakland Supplies

• Dental Clinic/Center in Forest Park, GA
• Providers in Forest Park, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.