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WINDWARD PEDIATRIC DENTISTRY NPI 1619013802


NPI Information

NPI: 1619013802
Provider Name: WINDWARD PEDIATRIC DENTISTRY
Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

CLIA Number: 11D1105869

Address:
11730 JONES BRIDGE RD
STE B, C, & D
ALPHARETTA, GA
ZIP 30005
Phone: (770) 344-0170
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WINDWARD PEDIATRIC DENTISTRY is a pediatric dentistry dentist in Alpharetta, GA. The provider is 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. WINDWARD PEDIATRIC DENTISTRY NPI is 1619013802. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

11730 JONES BRIDGE RD
STE B, C, & D
ALPHARETTA, GA
ZIP 30005-077
Phone: (770) 344-0170
Fax: (770) 344-0169

The provider's authorized official is Yangsun Bak .
The authorized official title is President and has the following contact phone number (770) 344-0170.

The CLIA number assigned to this NPI record is 11D1105869 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/29/2007 and was last updated on 8/22/2020.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0221XDentistPediatric DentistryDN012679GEORGIANo
21223P0221XDentistPediatric DentistryDN012678GEORGIAYes

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: 11/14/2023

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