NPIMap

Organization Active NPI

Family Dental, PC

  • Pediatric Dentistry
  • Riverdale, GA
National Provider Identifier
1861886111
Registry record updated Mar 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DN012467 Issued in GA
Legal business name
FAMILY DENTAL, PC
Practice address
12 Rountree Rd
Riverdale, GA 30274-4036
Phone
(678) 913-4912
NPI assigned
Mar 25, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2015

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

Authorized official

Name
Monica McIntyre, DDS
Title
Owner
Phone
(678) 565-1985

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X DN012467 GA Primary

Addresses

Primary practice location

12 Rountree Rd
Riverdale, GA 30274-4036

Mailing address

31 Highway 138 W
Suite 160
Stockbridge, GA 30281-4320
Phone (678) 913-4912

Other identifiers 1

IdentifierTypeStateIssuer
000925735HMedicaidGA

National Provider Directory

National Provider Directory

Locations

31 Highway 138 W
Ste 160
Stockbridge, GA 30281

NPI Registry JSON

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

{
    "created_epoch": "1427241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427241600000",
    "number": "1861886111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 HIGHWAY 138 W",
            "address_2": "SUITE 160",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814320",
            "telephone_number": "678-913-4912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 ROUNTREE RD",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302744036",
            "telephone_number": "678-913-4912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-25",
        "last_updated": "2015-03-25",
        "status": "A",
        "authorized_official_last_name": "MCINTYRE",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-565-1985",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN012467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000925735H",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; 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.