NPIMap

Organization Active NPI

Hartley Bridge Family Dentistry

  • General Practice Dentistry
  • Macon, GA
National Provider Identifier
1104206713
Registry record updated Nov 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN014540 Issued in GA
Legal business name
HARTLEY BRIDGE FAMILY DENTISTRY
Practice address
4226 Hartley Bridge Rd Ste 102
Macon, GA 31216
Phone
(478) 957-2486
NPI assigned
Jun 9, 2015
Last updated
Nov 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2019

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

Authorized official

Name
Dr. Leigh Underwood Bennett, D.M.DNPI 1881959518
Title
Dentist/Owner
Phone
(478) 957-2486

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN014540 GA Primary

Addresses

Primary practice location

4226 Hartley Bridge Rd Ste 102
Macon, GA 31216

Mailing address

4226 Hartley Bridge Rd Ste 102
Macon, GA 31216-4116
Phone (478) 957-2486

Other practice location 1

4319 Hartley Bridge Rd
Ste 130
Macon, GA 31216-5866
Phone (478) 958-2486

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190618000857 GA DME Supplier - Oral Surgery - Dentist 7315270782 Practice locations: Macon, GA

National Provider Directory

National Provider Directory

Locations

4226 Hartley Bridge Rd
Ste 102
Macon, GA 31216
Phone (478) 621-7657

4319 Hartley Bridge Rd
Ste 130
Macon, GA 31216
Phone (478) 957-2486

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": "1433808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574726400000",
    "number": "1104206713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4226 HARTLEY BRIDGE RD STE 102",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312164116",
            "telephone_number": "478-957-2486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4226 HARTLEY BRIDGE RD STE 102",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31216",
            "telephone_number": "478-957-2486"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4319 Hartley Bridge Rd",
            "address_2": "Ste 130",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312165866",
            "country_code": "US",
            "telephone_number": "478-958-2486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HARTLEY BRIDGE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-09",
        "last_updated": "2019-11-26",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "LEIGH",
        "authorized_official_middle_name": "UNDERWOOD",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "478-957-2486",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN014540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.