Active NPI
Ida Lynn Rose, DDS
- Pediatric Dentistry
- Lithia Springs, GA
National Provider Identifier
1972673135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN012631
- Practice address
- 540 Thornton Rd
Lithia Springs, GA 30122-1591 - Phone
- (770) 745-5897
- NPI assigned
- Nov 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN012631 | GA | Primary |
Addresses
Primary practice location
540 Thornton Rd
Lithia Springs, GA 30122-1591
Mailing address
540 Thornton Rd
Lithia Springs, GA 30122-1591
Phone (770) 745-5886
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN012631 | GA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777334400000",
"number": "1972673135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 THORNTON RD",
"city": "LITHIA SPRINGS",
"state": "GA",
"postal_code": "301221591",
"telephone_number": "770-745-5886",
"fax_number": "770-745-5897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 THORNTON RD",
"city": "LITHIA SPRINGS",
"state": "GA",
"postal_code": "301221591",
"telephone_number": "770-745-5897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "IDA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2026-04-28",
"certification_date": "2026-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "GA",
"license": "DN012631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lithia Springs, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.