PARKSIDE DENTAL PRACTICE NPI 1275634487

NPI Information

NPI: 1275634487
Provider Name: PARKSIDE DENTAL PRACTICE
Classification: Public Health or Welfare - 251K00000X
Entity Type: Organization
Address:
410 STEVENS ENTRY
PEACHTREE CITY, GA
ZIP 30269
Phone: (770) 487-8882
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PARKSIDE DENTAL PRACTICE is a public health or welfare in Peachtree City, GA. PARKSIDE DENTAL PRACTICE NPI is 1275634487. The provider is registered as an organization entity type.

The provider's business location address is:

410 STEVENS ENTRY
PEACHTREE CITY, GA
ZIP 30269
Phone: (770) 487-8882
Fax: (770) 486-9469

The provider's authorized official is Stephen L Matlaga Dds Gen Ptr .
The authorized official title is Owner and has the following contact phone number (770) 487-8882.

The enumeration date for this NPI number is 9/26/2006 and was last updated on 4/20/2008.

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	251K00000X	Public Health or Welfare		GA8697	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========	OTHER	GEORGIA	TIN

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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