NPIMap

Organization Active NPI

Marietta Family Dental Care, P.C.

  • Dentist
  • Marietta, GA
National Provider Identifier
1992966634
Registry record updated Aug 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN012848 Issued in GA
Legal business name
MARIETTA FAMILY DENTAL CARE, P.C.
Practice address
4720 Lower Roswell Rd
Marietta, GA 30068-4240
Phone
(770) 973-8222
NPI assigned
Jun 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2008

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

Authorized official

Name
Dr. Michael S Mansouri, DMD
Title
Owner/Dentist
Phone
(770) 973-8222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN012848 GA Primary

Addresses

Primary practice location

4720 Lower Roswell Rd
Marietta, GA 30068-4240

Mailing address

4720 Lower Roswell Rd
Marietta, GA 30068-4240
Phone (770) 973-8222

National Provider Directory

National Provider Directory

Locations

4720 Lower Roswell Rd
Marietta, GA 30068
Phone (770) 973-8222

Practitioners & affiliated clinicians

Practitioners 1

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": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217894400000",
    "number": "1992966634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4720 LOWER ROSWELL RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684240",
            "telephone_number": "770-973-8222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4720 LOWER ROSWELL RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684240",
            "telephone_number": "770-973-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA FAMILY DENTAL CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2008-08-05",
        "status": "A",
        "authorized_official_last_name": "MANSOURI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "770-973-8222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN012848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.