ANESTHESIOLOGISTS FOR DENTAL SEDATION LLC — NPI 1235754151 (Board-Certified Anesthesiologist & Interventional Pain Specialist in DACULA, GA)

CMS-1500 Box 24J / 33a • NPI

1235754151

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207L00000X (CMS 05)

Board-Certified Anesthesiologist & Interventional Pain Specialist

Box 32 Service Location & ZIP+4

3625 BRASELTON HWY STE 201, DACULA, GA, 30019-4695

✓ 9-Digit EDI 837 ZIP+4 (30019-4695)

Practice Phone & Referral Fax

(678) 889-2326

Fax: (470) 238-3658

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1235754151 (ANESTHESIOLOGISTS FOR DENTAL SEDATION LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1235754151` (NPI-2 Organization / Facility)
Provider / Legal Name	ANESTHESIOLOGISTS FOR DENTAL SEDATION LLC
Plain-English Specialty	Board-Certified Anesthesiologist & Interventional Pain Specialist NUCC Code: `207L00000X` (Anesthesiology)
Certifying / Licensing Body	American Board of Anesthesiology (ABA)
Practice Location Address	3625 BRASELTON HWY STE 201, DACULA, GA, 30019-4695
Practice Telephone / Fax	Tel: (678) 889-2326 \| Fax: (470) 238-3658
Administrative Mailing Address	3625 BRASELTON HWY STE 201, DACULA, GA, 30019-4695
Enumeration & Last Sync	Enumerated: 2020-06-16 \| CMS Record Updated: 2021-07-15
Authorized Official	CORY MANSOUR (Co-Founding Partner/Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

3625 BRASELTON HWY STE 201, DACULA, GA, 30019-4695

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Plain-English Taxonomy & CMS Crosswalk (207L00000X)

What Does Taxonomy Code 207L00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207L00000X translates to:
"Board-Certified Anesthesiologist & Interventional Pain Specialist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 05 (Physician/Anesthesiology) • CMS Code 79 (Physician/Addiction Medicine)
Certifying / Accrediting Authority: American Board of Anesthesiology (ABA)
Clinical Scope: Pre-surgical anesthesia evaluation, obstetric labor epidural care, or interventional spine and nerve block procedures for chronic pain.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ANESTHESIOLOGISTS FOR DENTAL SEDATION LLC)

Typical CPT / Diagnostic Procedures:

General Endotracheal Anesthesia & Total Intravenous Anesthesia (TIVA)
Ultrasound-Guided Peripheral Nerve Blocks & Labor Epidural Analgesia
Fluoroscopic Epidural Steroid Injections & Facet Joint Blocks

Common Therapeutic Classes:

Propofol, Sevoflurane, Rocuronium & Sugammadex
Bupivacaine, Lidocaine & Ropivacaine Regional Anesthetics

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207L00000X` — Anesthesiology Plain English: Board-Certified Anesthesiologist & Interventional Pain Specialist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ANESTHESIOLOGISTS FOR DENTAL SEDATION LLC (NPI #1235754151)