Peach Dental Care

Primary specialty

DentistTaxonomy code 122300000X

License

DN012520 Issued in GA

Legal business name

PEACH DENTAL CARE

Practice address

3596 W Hill St # B
Clarkston, GA 30021-1205

Phone

(770) 256-7555

NPI assigned

Mar 7, 2007

Last updated

Oct 18, 2016By 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

Thu VuNPI 1790956530

Title

DDS

Phone

(770) 256-7555

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Thu D. Vu, D.D.S.

  • General Practice Dentistry
  • Clarkston, GA
  • NPI 1790956530
  Authorized official Same address or phone

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1942331772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3596 W HILL ST # B",
            "city": "CLARKSTON",
            "state": "GA",
            "postal_code": "300211205",
            "telephone_number": "770-256-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3596 W HILL ST # B",
            "city": "CLARKSTON",
            "state": "GA",
            "postal_code": "300211205",
            "telephone_number": "770-256-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "VU",
        "authorized_official_first_name": "THU",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "770-256-7555"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN012520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "518280914A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Clarkston, GA
• Providers in Clarkston, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; 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.