Active NPI
Jason Matthew Bullock, DMD
- General Practice Dentistry
- Fort Benning, GA
National Provider Identifier
1093021545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8895
- Practice address
- 7101 Hoff St
Fort Benning, GA 31905-5645 - Phone
- (706) 544-4559
- NPI assigned
- Aug 23, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8895 | KY | Primary |
Addresses
Primary practice location
7101 Hoff St
Fort Benning, GA 31905-5645
Mailing address
Building 972 7061 Lincoln Avenue
USA Dental Activity
Fort Benning, GA 31905
Phone (706) 544-2118
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8895 | KY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680134400000",
"number": "1093021545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "BUILDING 972 7061 LINCOLN AVENUE",
"address_2": "USA DENTAL ACTIVITY",
"city": "FORT BENNING",
"state": "GA",
"postal_code": "31905",
"telephone_number": "706-544-2118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7101 HOFF ST",
"city": "FORT BENNING",
"state": "GA",
"postal_code": "319055645",
"telephone_number": "706-544-4559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "JASON",
"middle_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-23",
"last_updated": "2023-03-30",
"certification_date": "2023-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "8895",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Benning, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.