Av Dental Care, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN012273 Issued in GA

Legal business name

AV DENTAL CARE, PC

Doing business as

Patient 1st Dental

Practice address

3273 Shallowford Rd NE
Atlanta, GA 30341-3632

Phone

(770) 455-0628

Fax

(770) 451-7521

NPI assigned

Mar 7, 2007

Last updated

Aug 22, 2020By 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

Dr. Jaya Vallabhaneni, D.D.S.,NPI 1407846793

Title

Ceo

Phone

(770) 455-0628

Specialties & licenses 1

Addresses

Other names 1

• Patient 1st Dental Doing business as

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.

• Jaya Vallabhaneni, D.D.S.

  • General Practice Dentistry
  • Atlanta, GA
  • NPI 1407846793
  NPD (past) Authorized official

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922139567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3273 SHALLOWFORD RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303413632",
            "telephone_number": "770-455-0628",
            "fax_number": "770-451-7521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3273 SHALLOWFORD RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303413632",
            "telephone_number": "770-455-0628",
            "fax_number": "770-451-7521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AV DENTAL CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VALLABHANENI",
        "authorized_official_first_name": "JAYA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-455-0628",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S.,"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Patient 1st Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Atlanta, GA
• Providers in Atlanta, 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 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.