NPIMap

Organization Active NPI

Bray, DMD & Young, DMD, PC

  • General Practice Dentistry
  • Statesboro, GA
National Provider Identifier
1134235609
Registry record updated Nov 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9793 Issued in GA
Legal business name
BRAY, DMD & YOUNG, DMD, PC
Practice address
2 Lester CT
Statesboro, GA 30458-2118
Phone
(912) 489-1386
Fax
(912) 764-8533
NPI assigned
Aug 21, 2006
Last updated
Nov 6, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2007

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

Authorized official

Name
Dr. Cecil B Bray III, DMDNPI 1225209877
Title
President
Phone
(912) 489-1386

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 9793 GA Primary
Pediatric Dentistry 1223P0221X 10099 GA

Addresses

Primary practice location

2 Lester CT
Statesboro, GA 30458-2118

Mailing address

715 Northside Dr E
Suite 5, PMB 395
Statesboro, GA 30458-4712
Phone (912) 489-1386

Other identifiers 2

IdentifierTypeStateIssuer
00328314BMedicaidGA
00328622BMedicaidGA

National Provider Directory

National Provider Directory

Locations

2 Lester Ct
Statesboro, GA 30458
Phone (912) 489-1386

Practitioners & affiliated clinicians

Practitioners 2

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": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194307200000",
    "number": "1134235609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 NORTHSIDE DR E",
            "address_2": "SUITE 5, PMB 395",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304584712",
            "telephone_number": "912-489-1386",
            "fax_number": "912-764-8533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 LESTER CT",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304582118",
            "telephone_number": "912-489-1386",
            "fax_number": "912-764-8533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAY, DMD & YOUNG, DMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-11-06",
        "status": "A",
        "authorized_official_last_name": "BRAY",
        "authorized_official_first_name": "CECIL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-489-1386",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "9793",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "10099",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00328314B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00328622B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; 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.