DR. GINA B. MACK (NPI# 1689716839) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689716839 |
| Entity Type | Individual |
| Full Name | DR. GINA B. MACK |
| Credential | DMD |
| Practice Address |
2230 Towne Lake Parkway Bldg 1300, Ste 100 Woodstock GA 30189 |
| Mailing Address |
Po Box 195 Woodstock GA 30188 |
| Practice Telephone | 6784455444 |
| Practice Fax Number | 6784455552 |
| Mailing Telephone | 6784455444 |
| Mailing Fax Number | 6784455552 |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2009-01-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223D0001X |
Dentist Specialization: Dental Public Health |
DN011762 | GA | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DN011762 | GA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 9980277608B | 05 | |
| GA | DORAL DENTAL | 9210146 | 01 |
| GA | AVESIS | 102101 | 01 |
| Street Address |
2230 TOWNE LAKE PARKWAY BLDG 1300, STE 100 |
| City | WOODSTOCK |
| State | GA |
| Zip Code | 30189 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750361697 | Nayyer U Islam | Radiology | 2230 Towne Lake Parkway, Bldg, No. 900, Suite 250 & 150, Woodstock, GA 30189-5540 | 2006-01-18 |
| 1679705537 | Jane Wellesley Lewis | Dentist | 2230 Towne Lake Parkway, Building 1300. Ste 100, Woodstock, GA 30189 | 2009-08-11 |
| 1225269541 | Euna Yoo | Dentist | 2230 Towne Lake Parkway, Bldg 1300, Ste 100, Woodstock, GA 30189 | 2009-08-04 |
| 1932375128 | Menka Malhotra | Dentist | 2230 Towne Lake Parkway, Building 1300, Ste 100, Woodstock, GA 30189-5524 | 2008-05-07 |
| 1245427418 | Joseph Maturo Sease | Dentist | 2230 Towne Lake Parkway, Building 1300, Ste 100, Woodstock, GA 30189-5582 | 2007-10-01 |
| 1558480095 | Angela M Ojibway | Dentist | 2230 Towne Lake Parkway, Bldg 1300, Ste 100, Woodstock, GA 30189 | 2007-03-28 |
| 1679697064 | Charles Oakley Coulter | Dentist | 2230 Towne Lake Parkway, Building 1300 Suite 100, Woodstock, GA 30189 | 2007-03-19 |
| 1679635304 | Ohkyoung Chang | Dentist | 2230 Towne Lake Parkway, Bldg 1300, Ste 100, Woodstock, GA 30189 | 2006-12-16 |
| 1770683948 | John Mark Covington Jr. | Dentist | 2230 Towne Lake Parkway, Bldg 1300, Ste 100, Woodstock, GA 30189 | 2006-09-25 |
| 1942223102 | Daniel L Kerlan | Dentist | 2230 Towne Lake Parkway, Bldg 1300, Ste 100, Woodstock, GA 30189 | 2006-07-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801494356 | Susan Iruku | Pharmacist | 12050 Ga-92 #112, Woodstock, GA 30189 | 2020-10-15 |
| 1598267437 | Kelly Sierra | Nurse Practitioner | 100 Stoneforest Dr Ste 300, Woodstock, GA 30189 | 2018-03-07 |
| 1548770449 | Chandra Johnson | Nurse Practitioner | 295 Molly Lane Ste 150, Woodstock, GA 30189 | 2017-10-05 |
| 1083133912 | Amanda Bostock Sowisdral | Physician Assistant | 250 Parkbrooke Pl Ste 300, Woodstock, GA 30189 | 2017-09-12 |
| 1780101659 | Laura C Koch Woodstock LLC Dba Fountain View Dentistry | Dentist | 1816 Eagle Drive, Building 200-a, Woodstock, GA 30189 | 2017-08-23 |
| 1265954788 | Vicky Morton Bryan | Nurse Practitioner | 422 Sycamore Trail, Woodstock, GA 30189 | 2017-07-17 |
| 1063933588 | Marietta Eye Clinic, Pa | Optometrist | 2990 Eagle Dr Ste 110, Woodstock, GA 30189 | 2017-07-06 |
| 1275914749 | Nrup Tolat | Podiatrist | 100 Stoneforest Dr Ste 120, Woodstock, GA 30189 | 2015-06-10 |
| 1558781534 | Mary Jansson Carmon | Nurse Practitioner | 1000 Towne Lake Pkwy, Woodstock, GA 30189 | 2014-04-17 |
| 1518388941 | Afc Physicians of Georgia, PC | General Practice | 6440 Bells Ferry Rd, Woodstock, GA 30189 | 2014-01-03 |
| Find all providers in zip 30189 | ||||
| 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 |
|---|---|---|---|---|
| 1780220194 | Georgia Dental Professionals, PC | Dentist | 4355 Towne Lake Pkwy, Woodstock, GA 30189-8150 | 2019-11-20 |
| 1417422007 | Georgia Dental Professionals, PC | Dentist | 6759 Hickory Rd, Woodstock, GA 30188-2019 | 2018-10-10 |
| 1083197453 | Abb Dental Group LLC | Dentist | 11585 Us 14, Woodstock, IL 60098 | 2018-09-12 |
| 1780101659 | Laura C Koch Woodstock LLC Dba Fountain View Dentistry | Dentist | 1816 Eagle Drive, Building 200-a, Woodstock, GA 30189 | 2017-08-23 |
| 1578090056 | Woodstock Dentistry, PC | Dentist | 1428 Towne Lake Pkwy Ste 99, Woodstock, GA 30189-8265 | 2017-05-16 |
| 1871026724 | Bo Yeon Bartilotta | Dentist | 11585 Us-14, Woodstock, IL 60098 | 2017-04-07 |
| 1972985794 | David Haithcock | Dentist | 6304 Old Highway 5 Ste 100, Woodstock, GA 30188-2500 | 2015-06-29 |
| 1336552173 | Robert Clayton Cannon | Dentist | 8950 Main Street, Suite 120, Woodstock, GA 30188 | 2014-06-10 |
| 1669721783 | Robert Eugene Haraden | Dentist | 651 S. Eastwood Dr, Woodstock, IL 60098 | 2012-09-05 |
| 1942557004 | Sang-do David Lee | Dentist | 651 S. Eastwood Dr., Woodstock, IL 60098 | 2012-08-08 |
| Find all providers in WOODSTOCK | ||||
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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.