Innovative Smiles at the Forum PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

INNOVATIVE SMILES AT THE FORUM PC

Practice address

5185 Peachtree Pkwy
BLDG 1200 Ste 201
Norcross, GA 30092

Phone

(770) 368-1110

Fax

(770) 368-1114

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Philip K Talley, DDS

Title

Dentist Owner

Phone

(770) 368-1110

Specialties & licenses 1

Addresses

Other names 1

• Second Facility Opened Other name

Locations

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861403552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5185 PEACHTREE PKWY",
            "address_2": "BLDG 1200 STE 201",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30092",
            "telephone_number": "770-368-1110",
            "fax_number": "770-368-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5185 PEACHTREE PKWY",
            "address_2": "BLDG 1200 STE 201",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30092",
            "telephone_number": "770-368-1110",
            "fax_number": "770-368-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE SMILES AT THE FORUM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TALLEY",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "770-368-1110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Second Facility Opened",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dentist in Norcross, GA
• Providers in Norcross, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.