Active NPI
Stone Mountain Dental
- Health Maintenance Organization
- Stone Mountain, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Maintenance Organization
- License
- 012150
- Legal business name
- STONE MOUNTAIN DENTAL
- Practice address
- 4813 Rockbridge Rd Ste 26
Stone Mountain, GA 30083-4200 - Phone
- (404) 292-8383
- Fax
- (404) 292-8344
- NPI assigned
- Oct 24, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Schadale Stevens, D.D.S.
- Title
- President
- Phone
- (404) 292-8383
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | 012150 | GA | Primary |
Addresses
Primary practice location
4813 Rockbridge Rd Ste 26
Stone Mountain, GA 30083-4200
Mailing address
4813 Rockbridge Rd Ste 26
Stone Mountain, GA 30083-4200
Phone (404) 292-8383
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00090964A | Medicaid | GA |
National Provider Directory
National Provider Directory- Tax ID family
- Stone Mountain Dental
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Practice Dentistry
- Stone Mountain, GA
- NPI 1194997726
Locations
4813 Rockbridge Rd
Ste 26
Stone Mountain, GA 30083
Phone (404) 292-8383
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- Stone Mountain, GA
- NPI 1386798346
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224806400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1224806400000",
"number": "1992958722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4813 ROCKBRIDGE RD STE 26",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300834200",
"telephone_number": "404-292-8383",
"fax_number": "404-292-8344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4813 ROCKBRIDGE RD STE 26",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300834200",
"telephone_number": "404-292-8383",
"fax_number": "404-292-8344"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STONE MOUNTAIN DENTAL",
"organizational_subpart": "NO",
"enumeration_date": "2008-10-24",
"last_updated": "2008-10-24",
"status": "A",
"authorized_official_last_name": "STEVENS",
"authorized_official_first_name": "SCHADALE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "404-292-8383",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.D.S."
},
"taxonomies": [
{
"code": "302R00000X",
"taxonomy_group": "",
"desc": "Health Maintenance Organization",
"state": "GA",
"license": "012150",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00090964A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stone Mountain, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.