NPIMap

Organization Active NPI

Childrens Dentistry of Woodstock

  • Pediatric Dentistry
  • Woodstock, GA
National Provider Identifier
1902965932
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
CHILDRENS DENTISTRY OF WOODSTOCK
Practice address
2230 Towne Lake Pkwy
BLDG 1300 Ste 100
Woodstock, GA 30189
Phone
(678) 455-5444
Fax
(678) 455-5552
NPI assigned
Dec 6, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Brian Smith
Title
Controller
Phone
(678) 445-5444

Specialties & licenses 1

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

Addresses

Primary practice location

2230 Towne Lake Pkwy
BLDG 1300 Ste 100
Woodstock, GA 30189

Mailing address

PO Box 195
Woodstock, GA 30188
Phone (678) 445-5444

National Provider Directory

National Provider Directory

Locations

2230 Towne Lake Pkwy
Bldg 1300
Woodstock, GA 30189
Phone (678) 455-5444

Practitioners & affiliated clinicians

Practitioners 10

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": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902965932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 195",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "30188",
            "telephone_number": "678-445-5444",
            "fax_number": "678-445-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 TOWNE LAKE PKWY",
            "address_2": "BLDG 1300 STE 100",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "30189",
            "telephone_number": "678-455-5444",
            "fax_number": "678-455-5552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS DENTISTRY OF WOODSTOCK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "678-445-5444"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.