NPIMap

Organization Active NPI

Jupiter Cruize, Inc.

Doing business as Belvedere Plaza Dental

  • Dentist
  • Decatur, GA
National Provider Identifier
1952776171
Registry record updated Dec 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
11863 Issued in GA
Legal business name
JUPITER CRUIZE, INC.
Doing business as
Belvedere Plaza Dental
Practice address
3521 Memorial Dr
Suite a
Decatur, GA 30032-2731
Phone
(404) 567-8485
Fax
(404) 941-7719
NPI assigned
Dec 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2015

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

Authorized official

Name
Dr. Abbas Haider, DDSNPI 1245432004
Title
President/Dentist
Phone
(404) 567-8485

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 11863 GA Primary

Addresses

Primary practice location

3521 Memorial Dr
Suite a
Decatur, GA 30032-2731

Mailing address

3521 Memorial Dr
Suite a
Decatur, GA 30032-2731
Phone (404) 567-8485

Other identifiers 1

IdentifierTypeStateIssuer
433919119AMedicaidGA

Other names 1

  • Belvedere Plaza Dental Doing business as

National Provider Directory

National Provider Directory

Locations

3521 Memorial Dr
#A
Decatur, GA 30032
Phone (404) 567-8485

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450051200000",
    "number": "1952776171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3521 MEMORIAL DR",
            "address_2": "SUITE A",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300322731",
            "telephone_number": "404-567-8485",
            "fax_number": "404-941-7719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3521 MEMORIAL DR",
            "address_2": "SUITE A",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300322731",
            "telephone_number": "404-567-8485",
            "fax_number": "404-941-7719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUPITER CRUIZE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-14",
        "last_updated": "2015-12-14",
        "status": "A",
        "authorized_official_last_name": "HAIDER",
        "authorized_official_first_name": "ABBAS",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "404-567-8485",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "11863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "433919119A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Belvedere Plaza Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; 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.