Lifetime Dental Group LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN014333 Issued in GA

Legal business name

LIFETIME DENTAL GROUP LLC

Doing business as

Gwinnett Place Dental

Practice address

3796 Satellite Blvd
Duluth, GA 30096-5699

Phone

(770) 476-4140

Fax

(770) 497-9435

NPI assigned

Sep 20, 2011

Last updated

Sep 20, 2011By 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. Fabiola Palacios-Barrionuevo, DDSNPI 1265712483

Title

Member

Phone

(770) 842-4900

Specialties & licenses 1

Addresses

Other names 1

• Gwinnett Place 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.

• Fabiola Isabel Palacios-Barrionuevo, D.D.S.

  • General Practice Dentistry
  • Suwanee, GA
  • NPI 1265712483
  NPD (past) Authorized official

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1922380633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 SHILOH RIDGE RUN",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3796 SATELLITE BLVD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300965699",
            "telephone_number": "770-476-4140",
            "fax_number": "770-497-9435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-20",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "PALACIOS-BARRIONUEVO",
        "authorized_official_first_name": "FABIOLA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "770-842-4900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN014333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gwinnett Place Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Duluth, GA
• Providers in Duluth, 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 Sep 20, 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.