Provider Demographics
NPI:1639899065
Name:SWEET MAPLE PEDIATRIC DENTISTRY PC
Entity Type:Organization
Organization Name:SWEET MAPLE PEDIATRIC DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-653-3740
Mailing Address - Street 1:3251 LOST MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-8451
Mailing Address - Country:US
Mailing Address - Phone:770-653-3740
Mailing Address - Fax:
Practice Address - Street 1:56 HAWKINS LN
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-5476
Practice Address - Country:US
Practice Address - Phone:770-653-3740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1922462613Medicaid