NPIMap

Organization Active NPI

Nassetta Pediatric Dentistry, LLC

  • Pediatric Dentistry
  • Cullman, AL
National Provider Identifier
1992963193
Registry record updated May 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
5294 Issued in AL
Legal business name
NASSETTA PEDIATRIC DENTISTRY, LLC
Practice address
1705 Main Ave SW
Suite a
Cullman, AL 35055-7206
Phone
(256) 739-6000
NPI assigned
May 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2008

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

Authorized official

Name
Dr. Patrick Conrad Nassetta, DMDNPI 1619142270
Title
President
Phone
(205) 586-5806

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 5294 AL Primary

Addresses

Primary practice location

1705 Main Ave SW
Suite a
Cullman, AL 35055-7206

Mailing address

1705 Main Ave SW
Suite a
Cullman, AL 35055-7206
Phone (256) 739-6000

National Provider Directory

National Provider Directory

Locations

1705 Main Ave SW
Ste A
Cullman, AL 35055
Phone (256) 739-6000

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": "1211760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211760000000",
    "number": "1992963193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 MAIN AVE SW",
            "address_2": "SUITE A",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350557206",
            "telephone_number": "256-739-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 MAIN AVE SW",
            "address_2": "SUITE A",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350557206",
            "telephone_number": "256-739-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NASSETTA PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-26",
        "last_updated": "2008-05-26",
        "status": "A",
        "authorized_official_last_name": "NASSETTA",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "CONRAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "205-586-5806",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AL",
            "license": "5294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cullman, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.

Verify at the official NPI Registry.