STATESBORO PEDIATRIC DENTISTRY, LLC (NPI# 1568935286) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568935286 |
| Entity Type | Organization |
| Organization Name | STATESBORO PEDIATRIC DENTISTRY, LLC |
| Practice Address |
613 E Grady St Statesboro GA 30458-5104 |
| Mailing Address |
101 Irongate Pl Statesboro GA 30458-9195 |
| Practice Telephone | 4784565907 |
| Mailing Telephone | 4784565907 |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2019-01-04 |
| Authorized Official Name | DR. ANJALI PURI PATEL (DENTIST/OWNER) |
| Authorized Official Telephone | 4784565907 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Street Address |
613 E GRADY ST |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458-5104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811911977 | Rodrigo Lorenzo Uribe | Dentist | 613 E Grady St, Statesboro, GA 30458-5104 | 2006-07-26 |
| 1215270970 | East Georgia Center for Oral & Facial Surgery LLC | Dentist | 613 E Grady St, Statesboro, GA 30458-5104 | 2013-04-01 |
| 1144543372 | Anjali Puri Patel | Dentist | 613 E Grady St, Statesboro, GA 30458-5104 | 2010-03-02 |
| 1184946337 | East Georgia Oral & Maxillofacial Surgery Center | Clinic/Center | 613 E Grady St, Statesboro, GA 30458-5104 | 2010-02-15 |
| 1326185349 | Suketu J. Patel | Dentist | 613 E Grady St, Statesboro, GA 30458-5104 | 2007-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639642218 | Youtherapy | Counselor | 430 Northside Dr East, Suite 160 Mb326, Statesboro, GA 30458 | 2019-01-07 |
| 1053891853 | Alexandria Franklin | Specialist/Technologist | 1332 Southern Dr, Statesboro, GA 30458 | 2018-08-21 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1689186405 | Chandler James Herman | Specialist/Technologist | 590 Herty Dr., Statesboro, GA 30458 | 2017-11-02 |
| 1477009181 | Mama Doc Pediatrics, LLC | Pediatrics | 400 East Grady Street, Statesboro, GA 30458 | 2016-09-01 |
| 1053761171 | Rebekah Roessler | Specialist/Technologist | 2687 Akins Blvd, Statesboro, GA 30458 | 2016-06-20 |
| 1427412253 | Refocus Counseling and Consulting Services | Community/Behavioral Health | 4325 Country Club, 4, Statesboro, GA 30458 | 2016-04-07 |
| 1023408523 | Kacy H. Nesmith | Nurse Practitioner | 1098 Bermuda Run, Suite 6, Statesboro, GA 30458 | 2015-02-04 |
| 1760870398 | Jessica Pasternack | Specialist/Technologist | 2687 Akins Boulevard, Statesboro, GA 30458 | 2015-01-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| Find all providers in zip 30458 | ||||
| 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 |
|---|---|---|---|---|
| 1871145557 | Dogwood Pediatric Dentistry of Statesboro, LLC | Dentist | 123 Hill Pond Ln, Statesboro, GA 30458-0872 | 2019-07-12 |
| 1134235609 | Bray, Dmd & Young, Dmd, PC | Dentist | 2 Lester Ct, Statesboro, GA 30458-2118 | 2006-08-21 |
| 1821061557 | John Lyndon Wasdin | Dentist | 1501 Brampton Ave, Statesboro, GA 30458-0856 | 2006-02-13 |
| 1043481609 | Sally Young | Dentist | 2 Lester Ct, Statesboro, GA 30458-2118 | 2008-03-21 |
| 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 |
| 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 |
| 1275018582 | Jarrell Pediatric Dentistry, LLC | Dentist | 1538 13th Ave Ste 100, Columbus, GA 31901-1956 | 2018-10-02 |
| Find all providers with the same taxonomy | ||||
| City | STATESBORO |
| Zip Code | 30458 |
Please comment or provide details below to improve the information on STATESBORO PEDIATRIC DENTISTRY, LLC.
| 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.