Active NPI
Kelli Erin Zudekoff, DMD
- Dentist
- Suwanee, GA
National Provider Identifier
1861008294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN016144-T
- Practice address
- 350 Town Center Ave Ste 301
Suwanee, GA 30024-6914 - Phone
- (678) 448-4121
- NPI assigned
- Sep 21, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN016144-T | GA | Primary |
Addresses
Primary practice location
350 Town Center Ave Ste 301
Suwanee, GA 30024-6914
Mailing address
716 Creston Hill Way
Loganville, GA 30052-5672
Phone (678) 491-1032
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN016144-T | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600646400000",
"number": "1861008294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "716 CRESTON HILL WAY",
"city": "LOGANVILLE",
"state": "GA",
"postal_code": "300525672",
"telephone_number": "678-491-1032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 TOWN CENTER AVE STE 301",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300246914",
"telephone_number": "678-448-4121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZUDEKOFF",
"first_name": "KELLI",
"middle_name": "ERIN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-21",
"last_updated": "2020-09-21",
"certification_date": "2020-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN016144-T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suwanee, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.