NPIMap

Organization Active NPI

Towne Lake Dental Group, LLC

  • General Practice Dentistry
  • Pooler, GA
National Provider Identifier
1053696781
Registry record updated Oct 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
09617 Issued in GA
Legal business name
TOWNE LAKE DENTAL GROUP, LLC
Practice address
125 Southern Junction Blvd
Suite 701
Pooler, GA 31322-2214
Phone
(912) 330-4545
NPI assigned
Oct 13, 2011
Last updated
Oct 13, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Brian Beaudreau, D.M.D.
Title
Owner/Dentist
Phone
(912) 330-4545

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 09617 GA Primary

Addresses

Primary practice location

125 Southern Junction Blvd
Suite 701
Pooler, GA 31322-2214

Mailing address

125 Southern Junction Blvd
Suite 701
Pooler, GA 31322-2214
Phone (912) 330-4545

National Provider Directory

National Provider Directory

Locations

125 Southern Junction Blvd
Ste 701
Pooler, GA 31322
Phone (912) 330-4545

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318464000000",
    "number": "1053696781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 SOUTHERN JUNCTION BLVD",
            "address_2": "SUITE 701",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313222214",
            "telephone_number": "912-330-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 SOUTHERN JUNCTION BLVD",
            "address_2": "SUITE 701",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313222214",
            "telephone_number": "912-330-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWNE LAKE DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-13",
        "last_updated": "2011-10-13",
        "status": "A",
        "authorized_official_last_name": "BEAUDREAU",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "912-330-4545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "09617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pooler, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.