Unknown Individual – Oral and Maxillofacial Surgery (Dentist), NPI 1003920794

Unknown Individual is a healthcare provider. based in Peachtree city, Georgia. specializing in Oral and Maxillofacial Surgery (Dentist). They hold a License No. 010648 (GA). The NPI Number for Unknown Individual is 1003920794

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1003920794
Phone
(770) 487-3807
Address
400 STEVENS ENTRY
Deactivation Date
23 April 2026
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Stevens Entry, Stevens Forest, Fernwood, Peachtree City, Fayette County, Georgia, 30269, United States

    PEACHTREE CITY, GA 302694050

    Phone: (770) 487-3807

    Fax: (770) 487-1259

    Type: Mailing

  • Jefferson Parkway, McBride, Newnan, Coweta County, Georgia, 30263, United States

    NEWNAN, GA 302635822

    Phone: (770) 304-5577

    Fax: (770) 304-5550

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $33.

Total Amount is formed as General ($33) + Research ($0) + Ownership ($0) = $33.

Last reported payment date: 2024-03-27 • Largest payer in this snapshot: Geistlich Pharma, North America, Inc. ($20).

Total Amount

$33

General + Research + Ownership

Payments

2

Total payment records

General Amount

$33

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-03-27

Latest reported date

Top Companies

Largest payers in this snapshot

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 30269)

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Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1003920794.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Oral and Maxillofacial Surgery (Dentist). Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Peachtree City, Georgia. Check all listed addresses for suites or satellite offices.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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