MALL OF GEORGIA DENTISTRY (NPI# 1871943662) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871943662 |
| Entity Type | Organization |
| Organization Name | MALL OF GEORGIA DENTISTRY |
| Practice Address |
1905 Mall of Georgia Blvd Ste 1 Buford GA 30519 |
| Practice Telephone | 6787146343 |
| Practice Fax Number | 6787146345 |
| Mailing Telephone | 6787146343 |
| Mailing Fax Number | 6787146345 |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2018-05-02 |
| Authorized Official Name | ALLISON VANCIL (OFFICE MANAGER) |
| Authorized Official Telephone | 6787146343 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
012441 | GA | Ambulatory Health Care Facilities |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
012441 | GA | Dental Providers |
| Street Address |
1905 MALL OF GEORGIA BLVD STE 1 |
| City | BUFORD |
| State | GA |
| Zip Code | 30519 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699796771 | Brian D. Vancil | Dentist | 1905 Mall of Georgia Blvd Ste 1, Buford, GA 30519 | 2006-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154880763 | Walter Kalenik | Physical Therapist | 3694 Lake Rabun Ct, Buford, GA 30519 | 2019-03-14 |
| 1083127500 | Bunmi Yemisi Folarinde | Nurse Practitioner | 3616 S Bogan Rd Ste 202, Buford, GA 30519 | 2017-11-06 |
| 1124546817 | Jenny Chang | Pharmacist | 2635 General Lee Way, Buford, GA 30519 | 2017-09-02 |
| 1588181853 | Vincent Spencer | Nurse Practitioner | 2128 Mill Garden Run, Buford, GA 30519 | 2017-08-27 |
| 1225567597 | Vincentia Paul-constantin | Clinic/Center | 2867 Country House Lane, Buford, GA 30519 | 2017-06-08 |
| 1043668361 | Jacob Matthew Minor | Chiropractor | 2725 Hamilton Rd, Ste 500, Buford, GA 30519 | 2016-05-26 |
| 1477910941 | Nicole Camp | Nurse Practitioner | 2725 Mall of Georgia Blvd, Buford, GA 30519 | 2016-01-28 |
| 1235519240 | Moyra Renee Betuzzi-teas | Obstetrics & Gynecology | 2527 Mall of Georgia Blvd, Buford, GA 30519 | 2015-06-04 |
| 1104250950 | Coyette Annisee Telemaque | Nurse Practitioner | 3331 Hamilton Mill Rd Ste 1102, Buford, GA 30519 | 2013-08-29 |
| 1649552134 | Indira Ashok Patel | Physical Medicine & Rehabilitation | 2839 Hidden Falls Drive, Buford, GA 30519 | 2011-09-12 |
| Find all providers in zip 30519 | ||||
| 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 |
|---|---|---|---|---|
| 1063028769 | Georgia Dental Professionals, PC | Dentist | 3364 Hamilton Mill Rd, Buford, GA 30519-4005 | 2020-09-17 |
| 1821643255 | Priyanka Tayee | Dentist | 3730 Buford Dr, Buford, GA 30519-4920 | 2019-08-02 |
| 1861956005 | Michelle Sonnenfeldt Mckenzie | Dentist | 3700 Ridge Rd Ste A, Buford, GA 30519-4035 | 2019-01-22 |
| 1932603669 | Buford Family Dental Care, LLC | Dentist | 600 Garnett St Ste 3, Buford, GA 30518-3200 | 2018-03-19 |
| 1295264810 | Amanda Marie Newberry | Dentist | 5328 Lanier Islands Pkwy Ste 200, Buford, GA 30518-9056 | 2017-06-07 |
| 1114470705 | Randolph S Moore Dmd PC | Dentist | 4470 Commerce Dr, Suite B, Buford, GA 30518-7510 | 2016-07-29 |
| 1366888026 | Caroline Ceneviz | Dentist | 4125 Buford Dr Ste K, Buford, GA 30518-3459 | 2013-05-21 |
| 1447569850 | Buford Dental Associates PC | Dentist | 1879 Buford Hwy, Suite 5, Buford, GA 30518-3628 | 2010-10-03 |
| 1457508491 | Anca Nicola | Dentist | 4524 Brogdan Farm Court, Buford, GA 30518-8779 | 2008-08-21 |
| 1992987218 | Kwang R Pyon | Dentist | 4108 Hamilton Mill Rd Ste 220, Buford, GA 30519-3914 | 2007-11-28 |
| Find all providers in BUFORD | ||||
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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.