NPIMap

Organization Active NPI

Georgia Dental Professionals, PC

  • General Practice Dentistry
  • Decatur, GA
National Provider Identifier
1992861637
Registry record updated Aug 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7624 Issued in GA
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Practice address
755 Commerce Dr
Suite 513
Decatur, GA 30030-2627
Phone
(404) 377-7711
Fax
(404) 377-6040
NPI assigned
Dec 28, 2006
Last updated
Aug 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2018

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

Authorized official

Name
Cassandra Petersen
Title
Credentialing Team Lead
Phone
(217) 540-8972

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 7624 GA Primary

Addresses

Primary practice location

755 Commerce Dr
Suite 513
Decatur, GA 30030-2627

Mailing address

755 Commerce Dr
Suite 513
Decatur, GA 30030-2627
Phone (404) 377-7711

National Provider Directory

National Provider Directory
Tax ID family
Georgia Dental Professionals PC72 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Ownership & related parties

Subparts reporting this organization as parent 61

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

View all 61

Practitioners & affiliated clinicians

Practitioners 4

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": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535500800000",
    "number": "1992861637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 COMMERCE DR",
            "address_2": "SUITE 513",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302627",
            "telephone_number": "404-377-7711",
            "fax_number": "404-377-6040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 COMMERCE DR",
            "address_2": "SUITE 513",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302627",
            "telephone_number": "404-377-7711",
            "fax_number": "404-377-6040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DENTAL PROFESSIONALS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2018-08-29",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8972"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "7624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 29, 2018; 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.