NPIMap

Organization Active NPI

Mark Shurett DDS PC

  • Clinic/Center
  • Conyers, GA
National Provider Identifier
1831363670
Registry record updated Apr 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MARK SHURETT DDS PC
Practice address
1806 Over Lake Dr SE
Conyers, GA 30013-1745
Phone
(770) 760-7900
Fax
(770) 760-1375
NPI assigned
Apr 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2008

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

Authorized official

Name
Joseph P Rhodes
Title
Vice President
Phone
(770) 760-7900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X GA Primary

Addresses

Primary practice location

1806 Over Lake Dr SE
Conyers, GA 30013-1745

Mailing address

1806 Over Lake Dr SE
Conyers, GA 30013-1745
Phone (770) 760-7900

Other names 1

  • Help A Child Smile - Urban Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Georgia Dental Outreach PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208131200000",
    "number": "1831363670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1806 OVER LAKE DR SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300131745",
            "telephone_number": "770-760-7900",
            "fax_number": "770-760-1375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1806 OVER LAKE DR SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300131745",
            "telephone_number": "770-760-7900",
            "fax_number": "770-760-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK SHURETT DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2008-04-14",
        "status": "A",
        "authorized_official_last_name": "RHODES",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "770-760-7900"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Help A Child Smile - Urban",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conyers, GA

Sources for this page

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

Verify at the official NPI Registry.