Forest Park Denture Center

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

FOREST PARK DENTURE CENTER

Practice address

4487 Jonesboro Rd
Forest Park, GA 30297-4316

Phone

(404) 549-9752

Fax

(404) 549-2786

NPI assigned

Sep 20, 2024

Last updated

Sep 20, 2024By 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

Kirk SudeallNPI 1770636011

Title

Dentist

Phone

(404) 549-9752

Specialties & licenses 1

Addresses

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.

• Kirk A Sudeall

  • General Practice Dentistry
  • Marietta, GA
  • NPI 1770636011
  NPD Authorized official

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

{
    "created_epoch": "1726790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1811714033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4487 JONESBORO RD",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302974316",
            "telephone_number": "404-549-9752",
            "fax_number": "404-549-2786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4487 JONESBORO RD",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302974316",
            "telephone_number": "404-549-9752",
            "fax_number": "404-549-2786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST PARK DENTURE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-20",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A",
        "authorized_official_last_name": "SUDEALL",
        "authorized_official_first_name": "KIRK",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "404-549-9752"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fahimot Oyinlola Faduyile, M.D.
• Family Pain Management LLC
• Valerie Farrell
• Jeffrey P Flash, D.P.M.
• Forest Park Anesthesia Partners LLC
• Forest Park Medical Group
• Forest Park Professional Group LLC
• Forest Park Professional Group LLC
• Forest Parkway Dental Group
• Fresno 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 Sep 20, 2024; 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.