NORTHEAST GEORGIA DENTAL GROUP (NPI# 1063904076) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063904076 |
| Entity Type | Organization |
| Organization Name | NORTHEAST GEORGIA DENTAL GROUP |
| Other Organization Name | BGW DENTAL GROUP |
| Practice Address |
1205 Friendship Road Braselton GA 30517 |
| Mailing Address |
1215 Vine St Ne Gainesville GA 30501-2535 |
| Practice Telephone | 7705324555 |
| Practice Fax Number | 7705368053 |
| Mailing Telephone | 7705324555 |
| Mailing Fax Number | 7705368053 |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2018-06-05 |
| Authorized Official Name | ANN SORENSEN (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 7705324555 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| BGW Dental Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013121359 | Northeast Georgia Dental Group | Dentist | 1200 Sherwood Park Dr Ne, Gainesville, GA 30501-3445 | 2007-05-09 |
| Street Address |
1205 FRIENDSHIP ROAD |
| City | BRASELTON |
| State | GA |
| Zip Code | 30517 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548772544 | Shaniqua Lynee Sims | Nurse Practitioner | 1515 River Pl Ste 280, Braselton, GA 30517 | 2017-10-30 |
| 1538671847 | Georgia Pain and Wellness Center | Durable Medical Equipment & Medical Supplies | 1255 Frienship Road, Suite 150, Braselton, GA 30517 | 2017-10-26 |
| 1295137735 | Connie Johnson | Occupational Therapy Assistant | 5373 Thompsons Mill Rd., Braselton, GA 30517 | 2014-09-16 |
| 1780970921 | Christopher Thomas Middendorf | Hospitalist | 1400 River Place, Braselton, GA 30517 | 2011-06-27 |
| 1407140999 | Ashley Williams Zimmerman | Registered Nurse | 1515 River Pl Ste 340, Braselton, GA 30517 | 2011-06-02 |
| 1891097382 | Thu Mong Tran Nguyen | Dentist | 1702 Ammon Falls Ct, Braselton, GA 30517 | 2010-12-03 |
| 1053436030 | Andrew L Tam | Dentist | 5122 Hwy 53, Braselton, GA 30517 | 2007-03-20 |
| 1871503987 | Kathy Baxendale Morse | Nurse Practitioner | 2695 Old Winder Hwy, Suite 200, Pediatric Associates, Braselton, GA 30517 | 2006-08-09 |
| 1073585782 | Champak Patel | Legal Medicine | 5196 Hwy 53, Braselton, GA 30517 | 2006-02-06 |
| 1770568792 | Prasad S Garimella | Internal Medicine | 1400 River Pl, Braselton, GA 30517 | 2005-12-13 |
| Find all providers in zip 30517 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437604824 | Ken Kai Cheng | Dentist | 2625 Old Winder Hwy, Suite G, Braselton, GA 30517-7020 | 2016-08-16 |
| 1457780256 | Alena Karol | Dentist | 2625 Old Winder Hwy Ste G, Braselton, GA 30517-7021 | 2013-11-02 |
| 1891097382 | Thu Mong Tran Nguyen | Dentist | 1702 Ammon Falls Ct, Braselton, GA 30517 | 2010-12-03 |
| 1801913751 | David Cooney | Dentist | 6323 Grand Hickory Dr, Suite 100d, Braselton, GA 30517-6272 | 2007-03-24 |
| 1336578731 | Samira Jafari | Dentist | 2625 Old Winder Hwy Ste G, Braselton, GA 30517-7021 | 2013-11-06 |
| 1144659996 | Heartland Dental Care of Georgia, P.C. | Dentist | 2625 Old Winder Hwy Ste G, Braselton, GA 30517-7021 | 2013-11-02 |
| 1518001957 | Ilisa Beth Stern | Dentist | 2095 Highway 211 Nw, Suite 6a, Braselton, GA 30517-3402 | 2007-02-19 |
| 1225191935 | Vineyards Dental Care | Dentist | 2095 Highway 211 Nw, Suite 6-a, Braselton, GA 30517-3402 | 2006-12-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427659028 | My Emergency Dental Ga, LLC | Dentist | 4811 Lower Roswell Rd Ste 108, Marietta, GA 30068-4345 | 2020-11-02 |
| 1417556630 | Feyishayo Dahunsi | Dentist | 50 Main Street Market Pl Se Ste 500, Cartersville, GA 30121-3312 | 2020-10-19 |
| 1568079143 | Bimala Gharti | Dentist | 7310 Village Creek Trce, Atlanta, GA 30328-6763 | 2020-09-28 |
| 1760098214 | Georgia Dental Professionals, PC | Dentist | 3000 Chapel Hill Rd Ste 104, Douglasville, GA 30135-1841 | 2020-09-21 |
| 1063028769 | Georgia Dental Professionals, PC | Dentist | 3364 Hamilton Mill Rd, Buford, GA 30519-4005 | 2020-09-17 |
| 1306452016 | Georgia Dental Professionals, PC | Dentist | 2680 Highway 34 E Ste A, Newnan, GA 30265-1330 | 2020-09-17 |
| 1720693690 | Georgia Dental Professionals, PC | Dentist | 3625 Browns Bridge Rd Ste 101, Cumming, GA 30028-4198 | 2020-09-09 |
| 1699385062 | Hetal Trivedi | Dentist | 930 Spring St Nw Unit 915-a, Atlanta, GA 30309-3816 | 2020-07-31 |
| 1285242693 | Georgia Dental Professionals, PC | Dentist | 5185 Peachtree Pkwy Ste 201, Norcross, GA 30092-6539 | 2020-07-22 |
| 1770101131 | Fatima Hassan | Dentist | 722 Bonnie Oaks Ln, Evans, GA 30809-6114 | 2020-07-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.