NPIMap

Organization Active NPI

Decatur Dental Group, LLC

  • General Practice Dentistry
  • Decatur, GA
National Provider Identifier
1891002531
Registry record updated Sep 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN010168 Issued in GA
Legal business name
DECATUR DENTAL GROUP, LLC
Practice address
3660 Flat Shoals Rd
Suite 100
Decatur, GA 30034-1632
Phone
(404) 243-0217
Fax
(404) 243-9313
NPI assigned
Sep 1, 2010
Last updated
Sep 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2011

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

Authorized official

Name
Resa Johnelle Roberts
Title
Organizer
Phone
(404) 556-1393

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN010168 GA Primary

Addresses

Primary practice location

3660 Flat Shoals Rd
Suite 100
Decatur, GA 30034-1632

Mailing address

3660 Flat Shoals Rd
Suite 100
Decatur, GA 30034-1632
Phone (404) 243-0217

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1283299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316563200000",
    "number": "1891002531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 FLAT SHOALS RD",
            "address_2": "SUITE 100",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300341632",
            "telephone_number": "404-243-0217",
            "fax_number": "404-243-9313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3660 FLAT SHOALS RD",
            "address_2": "SUITE 100",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300341632",
            "telephone_number": "404-243-0217",
            "fax_number": "404-243-9313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-01",
        "last_updated": "2011-09-21",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "RESA",
        "authorized_official_middle_name": "JOHNELLE",
        "authorized_official_title_or_position": "ORGANIZER",
        "authorized_official_telephone_number": "404-556-1393"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN010168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; 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.