Mall of Georgia Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

012441 Issued in GA

Legal business name

MALL OF GEORGIA DENTISTRY

Practice address

1905 Mall of Georgia Blvd Ste 1
Buford, GA 30519

Phone

(678) 714-6343

Fax

(678) 714-6345

NPI assigned

Jun 13, 2016

Last updated

May 2, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Allison Vancil

Title

Office Manager

Phone

(678) 714-6343

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brian D. Vancil, DMD

  • General Practice Dentistry
  • Buford, GA
  • NPI 1699796771
  NPD

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

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525219200000",
    "number": "1871943662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 MALL OF GEORGIA BLVD STE 1",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "30519",
            "telephone_number": "678-714-6343",
            "fax_number": "678-714-6345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 MALL OF GEORGIA BLVD STE 1",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "30519",
            "telephone_number": "678-714-6343",
            "fax_number": "678-714-6345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALL OF GEORGIA DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-13",
        "last_updated": "2018-05-02",
        "status": "A",
        "authorized_official_last_name": "VANCIL",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "678-714-6343"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "012441",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "012441",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Major Milestones Healthcare
• Jennifer Major
• Iana Malakian, MD
• Susan Tomlinson Malcolm, NP
• Malik Ventures, LLC
• Nicole C Mallory, PHLEBOTOMIST
• George Mani
• Nicole Joy Mann, OTR/L
• Yianna Manolakis, NP-C
• Helena Alexandra Manssuer, LPC

• General Practice Dentistry in Buford, GA
• Providers in Buford, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.

Verify at the official NPI Registry.