Donald a. Bethea, D.D.S., L.L.C.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN011225 Issued in GA

Legal business name

DONALD A. BETHEA, D.D.S., L.L.C.

Practice address

410 Lister St
Waycross, GA 31501-5226

Phone

(912) 285-1218

NPI assigned

Jun 18, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Donald Alan Bethea, D.D.S.NPI 1417053646

Title

Denitst/Owner

Phone

(912) 285-1218

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Donald Alan Bethea, D.D.S.

  • Pediatric Dentistry
  • Waycross, GA
  • NPI 1417053646
  NPD (past) Authorized official
• William C Hurst Sr., D.M.D.

  • Pediatric Dentistry
  • Waycross, GA
  • NPI 1295824951
  NPD (past)

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

{
    "created_epoch": "1403049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403049600000",
    "number": "1124432166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 LISTER ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015226",
            "telephone_number": "912-285-1218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 LISTER ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015226",
            "telephone_number": "912-285-1218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DONALD A. BETHEA, D.D.S., L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-18",
        "last_updated": "2014-06-18",
        "status": "A",
        "authorized_official_last_name": "BETHEA",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "DENITST/OWNER",
        "authorized_official_telephone_number": "912-285-1218",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN011225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003143408A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5440634",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Penny Marie Dilorenzo, CSFA
• Diversified Resources, Inc.
• Doctors' Office MD PC
• Donnel Cross Host Home
• Christopher E Dougherty, LPCC
• Jeffrey Quinn Dowis, MD
• Leslie Bennett Dowling, DPM
• Dr Daniel Mulder Optometry LLC

• All providers in Waycross, GA
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; 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.