PARKSIDE PEDIATRIC AND ORTHODONTIC CARE INC NPI 1366125395

NPI Information

NPI: 1366125395
Provider Name: PARKSIDE PEDIATRIC AND ORTHODONTIC CARE INC
Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

Address:
155 CARNEGIE PL STE 201A
FAYETTEVILLE, GA
ZIP 30214
Phone: (678) 228-4266
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PARKSIDE PEDIATRIC AND ORTHODONTIC CARE INC is a pediatric dentistry dentist in Fayetteville, GA. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. PARKSIDE PEDIATRIC AND ORTHODONTIC CARE INC NPI is 1366125395. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

155 CARNEGIE PL STE 201A
FAYETTEVILLE, GA
ZIP 30214-981
Phone: (678) 228-4266
Fax: (404) 521-4120

The provider's authorized official is Tarvoria Russ .
The authorized official title is Operations Manager and has the following contact phone number (404) 631-7303.

The enumeration date for this NPI number is 8/8/2023 and was last updated on 8/8/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0221X	Dentist	Pediatric Dentistry			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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