NPIMap

Organization Active NPI

Capital Dental Associates

  • General Practice Dentistry
  • Atlanta, GA
National Provider Identifier
1982817979
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12259 Issued in GA
Legal business name
CAPITAL DENTAL ASSOCIATES
Practice address
3833 Roswell Rd NE
Suite 100
Atlanta, GA 30342-4432
Phone
(404) 261-6794
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kendra Dawn Derrick, DDSNPI 1326112970
Title
Owner
Phone
(404) 261-6794

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 12259 GA Primary

Addresses

Primary practice location

3833 Roswell Rd NE
Suite 100
Atlanta, GA 30342-4432

Mailing address

3833 Roswell Rd NE
Suite 100
Atlanta, GA 30342-4432
Phone (404) 261-6794

National Provider Directory

National Provider Directory

Locations

3833 Roswell Rd NE
Ste 100
Atlanta, GA 30342
Phone (404) 261-6794

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982817979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3833 ROSWELL RD NE",
            "address_2": "SUITE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303424432",
            "telephone_number": "404-261-6794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3833 ROSWELL RD NE",
            "address_2": "SUITE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303424432",
            "telephone_number": "404-261-6794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DERRICK",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-261-6794",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "12259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • 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.