Diane Manning Pennington, D.M.D., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN011196 Issued in GA

Practice address

1891 Ga Highway 40 E
Suite 1104
Kingsland, GA 31548-6572

Phone

(912) 673-6545

Fax

(912) 576-1846

NPI assigned

Oct 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 17, 2017 through Oct 17, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oral Maxillo Facial Surgeons, Inc

  dba Oral Maxillofacial & Facial Plastic Surgeons

  • Oral and Maxillofacial Surgery (Dentist)
  • Omaha, NE
  • NPI 1760576813
  NPD (past)

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447891200000",
    "number": "1073695516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 HAWTHORN LN",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315584026",
            "telephone_number": "912-673-6545",
            "fax_number": "612-576-1846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 GA HIGHWAY 40 E",
            "address_2": "SUITE 1104",
            "city": "KINGSLAND",
            "state": "GA",
            "postal_code": "315486572",
            "telephone_number": "912-673-6545",
            "fax_number": "912-576-1846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNINGTON",
        "first_name": "DIANE",
        "middle_name": "MANNING",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-20",
        "last_updated": "2015-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN011196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Ann Partain, CMT
• Sejal Kamleshkumar Patel
• Sujay G Patel, M.D.
• Pediatric Therapies of SE Ga, LLC
• Peds and Parents Family Care, LLC
• Stephanie Ann Petersen, PTA
• Jessica Pickler, MOT, OTR/L
• Linda Edna Poloff, DMD
• Courtney Marie Popwell, DNP
• Margaret Peek Powell, LPC

• Oral and Maxillofacial Surgery (Dentist) in Kingsland, GA
• Providers in Kingsland, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.