MODERN COSMETIC DENTAL CARE, LLC (NPI# 1992103428) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992103428 |
| Entity Type | Organization |
| Organization Name | MODERN COSMETIC DENTAL CARE, LLC |
| Practice Address |
1750 Highway 11 Suite B Covington GA 30014 |
| Practice Telephone | 6785921125 |
| Mailing Telephone | 6785921125 |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2014-12-16 |
| Authorized Official Name | DR. TOM MAZZUCKELLI (MANAGER) |
| Authorized Official Telephone | 6785921125 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
DN011417 | GA | Ambulatory Health Care Facilities |
| Street Address |
1750 HIGHWAY 11 SUITE B |
| City | COVINGTON |
| State | GA |
| Zip Code | 30014 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801495635 | Cathy Cassandra Collins | Pharmacist | 3639 Hwy 278, Covington, GA 30014 | 2020-10-22 |
| 1154933877 | Atl Optical LLC | Optometrist | 3135 Highway 278 Ne, Covington, GA 30014 | 2020-08-24 |
| 1932737046 | Samagas House Org | Adult Companion | 1500 Mountain View Cirlcle, Conyers, GA 30014 | 2020-04-01 |
| 1356834360 | Covington Dental Care | Dentist | 4139 Baker Street, Suite 15, Covington, GA 30014 | 2018-06-13 |
| 1487190005 | New Avenues Assessment and Counseling Center LLC | Counselor | 3192 Spring Street, Covington, NEWTON 30014 | 2017-01-07 |
| 1275903973 | Jennifer Carol Bridges | Registered Nurse | 320 Malcom Lane, Covington, GA 30014 | 2015-10-07 |
| 1134598501 | Shelby Boggus King | Physician Assistant | 4181 Hospital Drive Ne, Suite 204, Covington, GA 30014 | 2015-09-16 |
| 1366829814 | Wendy Pazdur | Counselor | 5109 Hwy 278 East, Suite D, Covington, GA 30014 | 2015-05-05 |
| 1306235445 | Covington Center for Family Dentistry | Dentist | 10373 Industrial Blvd, Covington, GA 30014 | 2015-01-13 |
| 1558764548 | Caitlin Elizabeth Krieger | Physician Assistant | 7229 Wheat Street Ne, Covington, GA 30014 | 2014-10-03 |
| Find all providers in zip 30014 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578185096 | Dr. Raymond Poirrier Dds LLC | Clinic/Center | 1968 N Highway 190 Ste 11a, Covington, LA 70433-5158 | 2020-05-07 |
| 1851912711 | Covington Empower Orthodontics LLC - Dr Timothy M Poyadou Jr | Clinic/Center | 100 Tyler Sq Ste 4, Covington, LA 70433-3060 | 2020-05-01 |
| 1689184129 | Little P.C. | Clinic/Center | 13015 Brown Bridge Rd Ste 340&350, Covington, GA 30016-9111 | 2017-10-11 |
| 1548616501 | Andrew Higgins D.d.s, Pllc | Clinic/Center | 17327 Se 270th Pl, Suite 113, Covington, WA 98042-5451 | 2016-05-09 |
| 1760098180 | Baptistakwokdds1,pllc | Clinic/Center | 17265 Se Wax Rd Ste 101, Covington, WA 98042-9102 | 2020-09-21 |
| 1093376865 | Fountain County Dentistry, LLC | Clinic/Center | 1302 Pearl St, Covington, IN 47932-9760 | 2019-06-24 |
| 1912434507 | Covington Dental Partners, LLC | Clinic/Center | 10115 Crown Ridge Dr, Covington, GA 30014-8700 | 2017-05-15 |
| 1568910040 | Applegate Dentistry | Clinic/Center | 324 Greenup St, Covington, KY 41011-1755 | 2016-09-14 |
| 1114384914 | Dale L Evans LLC | Clinic/Center | 2104 Newton Dr Ne, Covington, GA 30014-2456 | 2016-01-25 |
| 1245612423 | Chris J. Lee, Dmd, Chris J. Park, Dds, Pllc | Clinic/Center | 16330 Se 256th St, Covington, WA 98042-4233 | 2015-06-24 |
| Find all providers in COVINGTON | ||||
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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.