SOUTHEAST ORAL DIAGNOSTICS LLC
NPI 1063378966
Dentist - Oral and Maxillofacial Pathology in Alpharetta, GA

Q: What is Southeast Oral Diagnostics LLC's NPI number?

The NPI number for Southeast Oral Diagnostics LLC is 1063378966. It was assigned to this organization in the NPPES registry on January 5, 2026.

Q: What is Southeast Oral Diagnostics LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Pathology, with taxonomy code 1223P0106X.

Active since January 05, 2026

282 RUCKER RD STE 110, ALPHARETTA, GA 30004(770) 992-4844 Get Directions Write a Review

NPPES record last updated: January 5, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Southeast Oral Diagnostics Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEAST ORAL DIAGNOSTICS LLC (NPI 1063378966) is a healthcare organization registered as an oral and maxillofacial pathology in Alpharetta, Georgia and active in the NPI registry since January 2026. The organization maintains 3 additional practice locations and lists Stephanie Wetzel, Owner/ Dentist, as its authorized official.

NPPES Registry Identity

NPI1063378966

Entity TypeOrganization

Primary Taxonomy1223P0106X

Legal Business NameSOUTHEAST ORAL DIAGNOSTICS LLC

Location Address282 RUCKER RD STE 110Alpharetta, GA 30004-5826

Mailing Address346 Preston AveLexington, KY 40502-1532 · (770) 992-4844

Phone(770) 992-4844

Organization SubpartNo

Authorized OfficialStephanie WetzelOwner/ Dentist · (770) 992-4844

Enumeration DateJanuary 5, 2026

NPPES CertifiedJanuary 5, 2026

✔ NPI 1063378966 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial PathologyDental Providers

Taxonomy Code1223P0106X

Definition

The specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations.

282 RUCKER RD STE 110, Alpharetta, GA 30004

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Secondary Practice Locations 3

Location 1550 Pharr Rd NE Ste 325Atlanta, GA 30305-3450 · Phone (404) 233-8221

Location 2755 Commerce Dr Ste ADecatur, GA 30030-2613 · Phone (404) 378-2331

Location 35555 Peachtree Dunwoody Rd Ste G56Atlanta, GA 30342-1700 · Phone (404) 252-5626

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southeast Oral Diagnostics Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Southeast Oral Diagnostics LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Stephanie Wetzel, DDS

Oral and Maxillofacial Pathology

NPI 1528217940

282 RUCKER RD STE 110
Alpharetta, GA 30004

(770) 992-4844

✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southeast Oral Diagnostics LLC's NPI number?

The NPI number for Southeast Oral Diagnostics LLC is 1063378966. It was assigned to this organization in the NPPES registry on January 5, 2026.

Where is Southeast Oral Diagnostics LLC located?

Southeast Oral Diagnostics LLC is located at 282 Rucker Rd Ste 110, Alpharetta, GA 30004. The listed phone number is (770) 992-4844.

What is Southeast Oral Diagnostics LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Pathology, with taxonomy code 1223P0106X.

Is Southeast Oral Diagnostics LLC enrolled in Medicare?

Yes. Southeast Oral Diagnostics LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southeast Oral Diagnostics LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Oral and Maxillofacial Pathology) reassigns their Medicare billing to Southeast Oral Diagnostics LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Southeast Oral Diagnostics LLC was last updated on January 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.