Dorian Grace Longshore, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015430 Issued in GA

Practice address

4799 Atlanta Hwy # 500
Loganville, GA 30052-7307

Phone

(404) 609-4661

NPI assigned

Jun 9, 2017

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

Enrolled in GA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BEFEBA/Endpoint/BEFEBA

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

{
    "created_epoch": "1496966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496966400000",
    "number": "1104355395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1746 HOLMES DR SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300944726",
            "telephone_number": "470-255-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4799 ATLANTA HWY # 500",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300527307",
            "telephone_number": "404-609-4661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONGSHORE",
        "first_name": "DORIAN",
        "middle_name": "GRACE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-09",
        "last_updated": "2017-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Loganville Eyecare, PC
• Loganville Family Dentistry
• Loganville Foot and Ankle
• Loganville Foot and Ankle Medicine LLC
• Loganville Pediatrics & Adolescent Care Associates
• Chrissy Leach Lort, MSW
• Loving Hearts for the Disabled LLC
• Loving Hearts for the Disabled LLC
• Noel Lukose
• Courtney Lynn, PT, DPT

• General Practice Dentistry in Loganville, GA
• Providers in Loganville, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.