PEDIATRIC DENTAL SPECIALIST OF HIRAM (NPI# 1245617364) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245617364 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTAL SPECIALIST OF HIRAM |
| Practice Address |
5604 Wendy Bagwell Pkwy Suite 1100 Hiram GA 30141-7813 |
| Practice Telephone | 7709430011 |
| Mailing Telephone | 7709430011 |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2015-04-27 |
| Authorized Official Name | DR. MINDY LYNN SIMMS (PRESIDENT) |
| Authorized Official Telephone | 3302896019 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DN013367 | GA | Dental Providers |
| Street Address |
5604 WENDY BAGWELL PKWY SUITE 1100 |
| City | HIRAM |
| State | GA |
| Zip Code | 30141-7813 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942297106 | Richard J Breckwoldt | Internal Medicine | 5604 Wendy Bagwell Pkwy, Suite 711, Hiram, GA 30141-7813 | 2005-10-04 |
| 1164878302 | Synergy Homecare of Nw Atlanta | In Home Supportive Care | 5604 Wendy Bagwell Pkwy, Suite 321, Hiram, GA 30141-7813 | 2016-05-06 |
| 1891164463 | Complete Display Systems, Inc. | In Home Supportive Care | 5604 Wendy Bagwell Pkwy, Suite 811, Hiram, GA 30141-7813 | 2015-09-24 |
| 1336562966 | Latorey Howard | Social Worker | 5604 Wendy Bagwell Pkwy, Suite 611, Hiram, GA 30141-7813 | 2014-02-03 |
| 1548572415 | Empowered2change LLC | Social Worker | 5604 Wendy Bagwell Pkwy, Suite 812, Hiram, GA 30141-7813 | 2010-07-08 |
| 1174852156 | Sha-rhonda M. Davis | Social Worker | 5604 Wendy Bagwell Pkwy, 812, Hiram, GA 30141-7813 | 2009-12-21 |
| 1598930141 | Pinnacle Pediatrics PC | Pediatrics | 5604 Wendy Bagwell Pkwy, Suite 1111, Hiram, GA 30141-7813 | 2008-04-24 |
| 1619174463 | Andrea Battaglia | Counselor | 5604 Wendy Bagwell Pkwy, Suite 411, Hiram, GA 30141-7809 | 2007-06-27 |
| 1093911992 | John Marlin Warren | Radiologic Technologist | 5604 Wendy Bagwell Pkwy, Suite 911, Hiram, GA 30141-7809 | 2007-06-26 |
| 1376749291 | Byron T Barnes | Radiologic Technologist | 5604 Wendy Bagwell Pkwy, Hiram, GA 30141-7809 | 2007-06-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801255690 | Belinda Lett Baker | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5316 Jones Reserve Walk, Hiram, GA 30141 | 2016-02-22 |
| 1104213339 | Matthew Lee Estes | Nurse Practitioner | 148 Bill Carruth Pkwy Ste 220, Hiram, GA 30141 | 2015-04-26 |
| 1881088649 | Marietta Eye Clinic, Pa | Optometrist | 47 Highland Pavilion Ct, Suite 101, Hiram, GA 30141 | 2015-03-19 |
| 1902217417 | Hiram Dental Group, PC | Dentist | 5218 Jimmy Lee Smith Parkway, Suite 100, Hiram, GA 30141 | 2014-05-19 |
| 1912340613 | Anuj Patel | Orthopaedic Surgery | 148 Bill Carruth Parkway Suite 120, Hiram, GA 30141 | 2013-04-11 |
| 1619280278 | Thomas Wayne Bloodworth | Obstetrics & Gynecology | 6794 Bill Carruth Parkway, Hiram, GA 30141 | 2010-07-23 |
| 1487970026 | Madelynn Lorraine Speach | Counselor | 44 Darbys Crossing Dr Ste 206c, Hiram, GA 30141 | 2010-04-07 |
| 1679760433 | We Care Md, P.C. | Family Medicine | 5610 Wendy Bagwell Parkway, Suite 103, Hiram, GA 30141 | 2007-09-26 |
| 1811188121 | Holly L Watson | Nurse Practitioner | 156 Hiram Drive, Building B, Hiram, GA 30141 | 2007-08-05 |
| 1285842799 | Restoration Physical Therapy, LLC. | Clinic/Center | 5077 Jimmy Lee Smith Pkwy, Suite 119, Hiram, GA 30141 | 2007-05-18 |
| Find all providers in zip 30141 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679566475 | Derek Deshan Mason | Dentist | 126 Enterprise Path, Hiram, GA 30141-2656 | 2005-08-26 |
| 1992873210 | Mindy Lynn Simms | Dentist | 5604 Wendy Bagwell Pkwy, Suite 1111, Hiram, GA 30141-7813 | 2006-12-04 |
| 1730275306 | Jason Edward Turner | Dentist | 126 Enterprise Path, Suite 106, Hiram, GA 30141 | 2006-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740895002 | Ashley Starnesdmd LLC | Dentist | 5482 Chamblee Dunwoody Rd Ste 9, Dunwoody, GA 30338-4142 | 2020-09-14 |
| 1912518531 | Samuel S Kwon - Athens Dmd PC | Dentist | 1795 Resurgence Drive, Suite 101, Watkinsville, GA 30677 | 2020-08-17 |
| 1366060618 | A Dental Home 4 Kidz | Dentist | 155 Carnegie Pl Ste 201, Fayetteville, GA 30214-3981 | 2020-07-13 |
| 1255973566 | Rehoboth Life Care Ministries, Inc | Dentist | 3208 Hwy 41, Byron, Byron, GA 31008 | 2019-10-09 |
| 1629619200 | Peachtree Hills Pediatric Dentistry | Dentist | 2385 Peachtree Rd Ne Ste A2ab, Atlanta, GA 30305-4139 | 2019-10-04 |
| 1871145557 | Dogwood Pediatric Dentistry of Statesboro, LLC | Dentist | 123 Hill Pond Ln, Statesboro, GA 30458-0872 | 2019-07-12 |
| 1952969396 | Ns3 Services, LLC | Dentist | 1039 Grant St Se Ste B11, Atlanta, GA 30315-2050 | 2019-05-31 |
| 1871050872 | Warner Robins Pediatric Dentistry LLC | Dentist | 102 S Houston Rd, Warner Robins, GA 31088-3904 | 2019-02-26 |
| 1730646886 | Smiles for Kids Norcross PC | Dentist | 3953 Holcomb Bridge Rd Ste 100, Peachtree Corners, GA 30092-5201 | 2019-02-25 |
| 1073083127 | Pediatric Dentistry of Central Georgia - Macon LLC | Dentist | 5437 Bowman Rd Ste 300, Macon, GA 31210-6575 | 2018-12-03 |
| 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.