Canton Marketplace Dentistry LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CANTON MARKETPLACE DENTISTRY LLC

Practice address

1810 Cumming Hwy Ste 900
Canton, GA 30115-2999

Phone

(770) 780-2465

Fax

(678) 880-0059

NPI assigned

Dec 21, 2018

Last updated

Dec 21, 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

Poya M MoghadamNPI 1720270309

Title

Owner

Phone

(678) 880-0087

Specialties & licenses 1

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.

• Poya Moghadam, DMD

  • General Practice Dentistry
  • Canton, GA
  • NPI 1720270309
  NPD (past) Authorized official

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

{
    "created_epoch": "1545350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545350400000",
    "number": "1891267316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 CUMMING HWY STE 900",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301152999",
            "telephone_number": "678-880-0087",
            "fax_number": "678-880-0059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 CUMMING HWY STE 900",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301152999",
            "telephone_number": "770-780-2465",
            "fax_number": "678-880-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON MARKETPLACE DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-21",
        "last_updated": "2018-12-21",
        "status": "A",
        "authorized_official_last_name": "MOGHADAM",
        "authorized_official_first_name": "POYA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-880-0087"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Canton Endodontics,LLC
• Canton Eye Surgery Center
• Canton Family Care
• Canton Institute for Physical Therapy, LLC
• Canton Market Place Medical, LLC
• Canton Northside Pharmacy Inc (Canton Northside Pharmacy)
• Canton Opco, LLC (The Landings of Canton Hills)
• Canton Orthodontics LLC
• Canton Orthopaedics and Sports Medicine, P.C.
• Canton Pediatric Dentistry PC

• General Practice Dentistry in Canton, GA
• Providers in Canton, 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 Dec 21, 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.