Purple Tooth Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PURPLE TOOTH DENTAL

Practice address

112 Woodlawn Ave
Mt Holly, NC 28120-1775

Phone

(704) 885-2266

NPI assigned

Nov 3, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Andy Mancini

Title

Ceo

Phone

(704) 885-2266

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jonathan Rainier Kaczmarski DMD, PLLC Other name

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636156800000",
    "number": "1841955945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 WOODLAWN AVE",
            "city": "MT HOLLY",
            "state": "NC",
            "postal_code": "281201775",
            "telephone_number": "704-885-2266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 WOODLAWN AVE",
            "city": "MT HOLLY",
            "state": "NC",
            "postal_code": "281201775",
            "telephone_number": "704-885-2266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURPLE TOOTH DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-03",
        "last_updated": "2021-11-06",
        "certification_date": "2021-11-06",
        "status": "A",
        "authorized_official_last_name": "MANCINI",
        "authorized_official_first_name": "ANDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-885-2266",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982835831",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jonathan Rainier Kaczmarski DMD, PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Cara M Price, M.S., CCC-SLP
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• Quiet Willow, PLLC
• Lilian Ray
• Raymond a. Jokubaitis, D.M.D., P.a.
• Remedy Sense Counseling, PLLC
• Monica K Rendon, LMBT

• Dental Clinic/Center in Mt Holly, NC
• Providers in Mt Holly, NC by specialty
• Dental Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2021; 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.