NPIMap

Organization Active NPI

Galloway Dental Implants and Periodontics, P.C.

  • Periodontics
  • Dothan, AL
National Provider Identifier
1053823005
Registry record updated Sep 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
GALLOWAY DENTAL IMPLANTS AND PERIODONTICS, P.C.
Practice address
102 Medical Dr
Dothan, AL 36303-6902
Phone
(334) 792-7888
Fax
(334) 792-8717
NPI assigned
Oct 31, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2021

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

Authorized official

Name
Jasmine M. Rodriguez
Title
Admin Asst.
Phone
(334) 792-7888

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 3595 AL
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

102 Medical Dr
Dothan, AL 36303-6902

Mailing address

102 Medical Dr
Dothan, AL 36303-6902
Phone (334) 792-7888

Other names 1

  • lewis g humphreys, jr Former legal business name

National Provider Directory

National Provider Directory

Locations

102 Medical Dr
Dothan, AL 36303
Phone (334) 792-7888

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1509408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632873600000",
    "number": "1053823005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 MEDICAL DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363036902",
            "telephone_number": "334-792-7888",
            "fax_number": "334-792-8717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 MEDICAL DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363036902",
            "telephone_number": "334-792-7888",
            "fax_number": "334-792-8717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLOWAY DENTAL IMPLANTS AND PERIODONTICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-31",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "JASMINE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "ADMIN ASST.",
        "authorized_official_telephone_number": "334-792-7888"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "AL",
            "license": "3595",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "lewis g humphreys, jr",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; 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.