NPIMap

Organization Active NPI

Clifford Avenue Dental LLC

Doing business as Screven Dental

  • General Practice Dentistry
  • Sylvania, GA
National Provider Identifier
1831954304
Registry record updated Feb 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CLIFFORD AVENUE DENTAL LLC
Doing business as
Screven Dental
Practice address
112 Clifford Ave
Sylvania, GA 30467-2012
Phone
(912) 564-7107
Fax
(912) 564-9349
NPI assigned
Feb 14, 2024
Last updated
Feb 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2024

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

Authorized official

Name
Jenny Garcia-Rocha
Title
Sr Team Lead
Phone
(972) 869-3789

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

112 Clifford Ave
Sylvania, GA 30467-2012

Mailing address

112 Clifford Ave
Sylvania, GA 30467-2012
Phone (912) 564-7107

Other names 1

  • Screven Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1707868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707868800000",
    "number": "1831954304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 CLIFFORD AVE",
            "city": "SYLVANIA",
            "state": "GA",
            "postal_code": "304672012",
            "telephone_number": "912-564-7107",
            "fax_number": "912-564-9349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 CLIFFORD AVE",
            "city": "SYLVANIA",
            "state": "GA",
            "postal_code": "304672012",
            "telephone_number": "912-564-7107",
            "fax_number": "912-564-9349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLIFFORD AVENUE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-14",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A",
        "authorized_official_last_name": "GARCIA-ROCHA",
        "authorized_official_first_name": "JENNY",
        "authorized_official_title_or_position": "SR TEAM LEAD",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Screven Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sylvania, GA

Sources for this page

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