Active NPI
Professional Dental Alliance of Georgia, LLC
- General Practice Dentistry
- Acworth, GA
National Provider Identifier
1861900946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN013474
- Legal business name
- PROFESSIONAL DENTAL ALLIANCE OF GEORGIA, LLC
- Practice address
- 3466 Cobb Pkwy NW Ste 170
Acworth, GA 30101-5768 - Phone
- (770) 203-1711
- Fax
- (404) 855-4104
- NPI assigned
- Jan 11, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Andrew Matta
- Title
- Owner
- Phone
- (724) 698-2500
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN013474 | GA | Primary |
Addresses
Primary practice location
3466 Cobb Pkwy NW Ste 170
Acworth, GA 30101-5768
Mailing address
11 S Mill St
New Castle, PA 16101-3680
Other practice location 1
10373 Industrial Blvd NE
Covington, GA 30014-1403
Phone (678) 306-6000
Other practice location 2
1867 Jonesboro Rd Ste 6
McDonough, GA 30253-6099
Phone (678) 432-0209
Other practice location 3
4353 Atlanta Hwy Ste 300
Loganville, GA 30052-3232
Phone (770) 450-2030
Other practice location 4
3230 Lawrenceville Suwanee Rd
300
Suwanee, GA 30024
Phone (724) 698-2500
Other practice location 5
740 Ferst Dr NW Suite 207
Atlanta, GA 30322-0001
Phone (404) 733-2022
Other practice location 6
4374 Atlanta Hwy Ste 109
Hiram, GA 30141-1849
Phone (770) 505-9898
Other practice location 7
5304 Windward Pkwy Ste 107
Alpharetta, GA 30004-3828
Phone (770) 777-1911
National Provider Directory
National Provider DirectoryLocations
3230 Lawrenceville Suwanee Rd
Ste 300
Suwanee, GA 30024
Phone (724) 698-2500
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- Atlanta, GA
- NPI 1578799789
-
- General Practice Dentistry
- Milton, GA
- NPI 1518273747
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515628800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1521244800000",
"number": "1861900946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 S MILL ST",
"city": "NEW CASTLE",
"state": "PA",
"postal_code": "161013680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3466 COBB PKWY NW STE 170",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301015768",
"telephone_number": "770-203-1711",
"fax_number": "404-855-4104"
}
],
"practiceLocations": [
{
"address_1": "10373 Industrial Blvd NE",
"address_purpose": "LOCATION",
"city": "Covington",
"state": "GA",
"postal_code": "300141403",
"country_code": "US",
"telephone_number": "678-306-6000",
"fax_number": "404-855-4104",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1867 Jonesboro Rd Ste 6",
"address_purpose": "LOCATION",
"city": "McDonough",
"state": "GA",
"postal_code": "302536099",
"country_code": "US",
"telephone_number": "678-432-0209",
"fax_number": "404-855-4104",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4353 Atlanta Hwy Ste 300",
"address_purpose": "LOCATION",
"city": "Loganville",
"state": "GA",
"postal_code": "300523232",
"country_code": "US",
"telephone_number": "770-450-2030",
"fax_number": "404-855-4104",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3230 Lawrenceville Suwanee Rd",
"address_2": "300",
"address_purpose": "LOCATION",
"city": "Suwanee",
"state": "GA",
"postal_code": "30024",
"country_code": "US",
"telephone_number": "724-698-2500",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "740 Ferst Dr NW Suite 207",
"address_purpose": "LOCATION",
"city": "Atlanta",
"state": "GA",
"postal_code": "303220001",
"country_code": "US",
"telephone_number": "404-733-2022",
"fax_number": "404-855-4104",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4374 Atlanta Hwy Ste 109",
"address_purpose": "LOCATION",
"city": "Hiram",
"state": "GA",
"postal_code": "301411849",
"country_code": "US",
"telephone_number": "770-505-9898",
"fax_number": "404-855-4104",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5304 Windward Pkwy Ste 107",
"address_purpose": "LOCATION",
"city": "Alpharetta",
"state": "GA",
"postal_code": "300043828",
"country_code": "US",
"telephone_number": "770-777-1911",
"fax_number": "404-855-4104",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "PROFESSIONAL DENTAL ALLIANCE OF GEORGIA, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-01-11",
"last_updated": "2018-03-17",
"status": "A",
"authorized_official_last_name": "MATTA",
"authorized_official_first_name": "ANDREW",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "724-698-2500"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN013474",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Acworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.