Palmetto Family Dental, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN013693 Issued in GA

Legal business name

PALMETTO FAMILY DENTAL, PC

Practice address

501 Park St
Palmetto, GA 30268-1007

Phone

(770) 463-4541

Fax

(770) 463-9184

NPI assigned

Apr 14, 2011

Last updated

Aug 30, 2023By 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. Jordan Albert Brunson, DDSNPI 1861631053

Title

President

Phone

(770) 463-4541

Specialties & licenses 1

Addresses

Other names 1

• Jordan A. Brunson, DDS, OC Former legal business name

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.

• Jordan Albert Brunson, D.D.S.

  • General Practice Dentistry
  • Palmetto, GA
  • NPI 1861631053
  NPD (past) Authorized official

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

{
    "created_epoch": "1302739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1841580560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 PARK ST",
            "city": "PALMETTO",
            "state": "GA",
            "postal_code": "302681007",
            "telephone_number": "770-463-4541",
            "fax_number": "770-463-9184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 PARK ST",
            "city": "PALMETTO",
            "state": "GA",
            "postal_code": "302681007",
            "telephone_number": "770-463-4541",
            "fax_number": "770-463-9184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO FAMILY DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-14",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "BRUNSON",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-463-4541",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jordan A. Brunson, DDS, OC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Jordan A. Brunson, DDS, OC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Nicole Morales, BCBA
• Kimmeone Morgan, RN
• Noble Grace Home Care LLC
• Nra-Palmetto, Georgia, LLC (Palmetto Dialysis Clinic)
• Daniell Odionesene, OT
• Palmetto Health Council Inc (Community Medical Center)
• Palmetto Health Council Inc (Palmetto Health Council Pharmacy)
• Palmetto Health Council Inc (Community Medical Center)
• Palmetto Health Council, Inc. (YourTownHealth)
• Palmetto Sleep PC

• General Practice Dentistry in Palmetto, GA
• Providers in Palmetto, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; 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.