FAMILY DENTISTRY OF NORTHLAKE
NPI 1215315312
Dentist - General Practice in Tucker, GA

Active since May 11, 2015
3983 LAVISTA RD STE 104, TUCKER, GA 30084(770) 723-1111 Get Directions Write a Review

NPPES record last updated: May 11, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

  • Organization
  • Dentist
  • General Practice

About FAMILY DENTISTRY OF NORTHLAKE

This page provides the complete NPI Profile along with additional information for Family Dentistry Of Northlake, a provider established in Tucker, Georgia operating as a Dentist, focusing in general practice . The healthcare provider is registered in the NPI registry with number 1215315312 assigned on May 2015. The practitioner's primary taxonomy code is 1223G0001X. The provider is registered as an organization and their NPI record was last updated 11 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's is doing business as Family Dentistry Of Northlake. The authorized official of this NPI record is Kim Wilson (Cred Sup)

NPI
1215315312 Verify this NPI
Provider Legal Name
GEORGIA DENTAL PROFESSIONALS, PC
Other Organization Name
FAMILY DENTISTRY OF NORTHLAKE
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
3983 LAVISTA RD STE 104 TUCKER, GA 30084
Location Phone
(770) 723-1111
Mailing Address
3983 LAVISTA RD STE 104 TUCKER, GA 30084
Mailing Phone
(770) 723-1111
Is Sole Proprietor?
No
Is Organization Subpart?
Yes
Enumeration Date
05-11-2015
Last Update Date
05-11-2015
Code Navigator

A dentist like Family Dentistry Of Northlake is a skilled in and licensed provider that diagnoses and treats problems with patients teeth, gums, and related parts of the mouth. Dentists educate patients on how to take care of the teeth and gums and provide information on diet choices that affect oral health. Dentists must be licensed in the state in which they work.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Dentist General Practice

Taxonomy Code
1223G0001X
Type
Dental Providers
Taxonomy Description
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.

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

KIM WILSON

Authorized Official Title
CRED SUP
Authorized Official Phone
(217) 540-5170

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Other Providers at the Same Location


The following 1 provider is registered at the same or a nearby location.

Dentist (General Practice)
3983 LAVISTA RD STE 104
TUCKER, GA 30084

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1215315312, enumerated as an "organization" on May 11, 2015.

The provider is located at 3983 LAVISTA RD STE 104 TUCKER, GA 30084 and the phone number is (770) 723-1111.

Dentist with taxonomy code 1223G0001X and a focus in General Practice.