NPIMap

Organization Active NPI

Gainesville Dental Group

  • General Practice Dentistry
  • Gainesville, GA
National Provider Identifier
1114181138
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN013665 Issued in KY
Legal business name
GAINESVILLE DENTAL GROUP
Practice address
426 Spring St
Gainesville, GA 30501
Phone
(770) 297-0401
Fax
(770) 297-8477
NPI assigned
Jul 18, 2008
Last updated
May 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Authorized official

Name
Paul E. Gannon, DMDNPI 1902238926
Title
Owner/Dentist
Phone
(770) 297-0401

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health Dentistry 1223D0001X DN11839 GA
Public Health Dentistry 1223D0001X DN013644 GA
General Practice Dentistry 1223G0001X DN013665 KY Primary

Addresses

Primary practice location

426 Spring St
Gainesville, GA 30501

Mailing address

426 Spring St
Gainesville, GA 30501
Phone (770) 297-0401

Other identifiers 1

IdentifierTypeStateIssuer
00883099DMedicaidGA

National Provider Directory

National Provider Directory

Locations

426 Spring St SE
Gainesville, GA 30501
Phone (770) 297-0401

Practitioners & affiliated clinicians

Practitioners 8

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": "1216339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1114181138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "426 SPRING ST",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "770-297-0401",
            "fax_number": "770-297-8477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 SPRING ST",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "770-297-0401",
            "fax_number": "770-297-8477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAINESVILLE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-18",
        "last_updated": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "GANNON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "770-297-0401",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "GA",
            "license": "DN11839",
            "primary": false
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "GA",
            "license": "DN013644",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "DN013665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00883099D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.