NPIMap

Organization Active NPI

Valdosta Center for Cosmetic Dentistry, Inc

  • General Practice Dentistry
  • Valdosta, GA
National Provider Identifier
1154723518
Registry record updated Sep 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN009147 Issued in GA
Legal business name
VALDOSTA CENTER FOR COSMETIC DENTISTRY, INC
Practice address
802 Northwood Park Dr
Valdosta, GA 31602-1392
Phone
(229) 242-0825
Fax
(229) 242-0167
NPI assigned
Sep 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2014

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

Authorized official

Name
Dr. James B. Bynum Sr., D.M.D.NPI 1144249673
Title
Owner
Phone
(229) 242-0825

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 DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DN009147 GA Primary

Addresses

Primary practice location

802 Northwood Park Dr
Valdosta, GA 31602-1392

Mailing address

802 Northwood Park Dr
Valdosta, GA 31602-1392
Phone (229) 242-0825

Other names 1

  • North Valdosta Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

802 Northwood Park Dr
Valdosta, GA 31602
Phone (229) 242-0825

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410912000000",
    "number": "1154723518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 NORTHWOOD PARK DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021392",
            "telephone_number": "229-242-0825",
            "fax_number": "229-242-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 NORTHWOOD PARK DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021392",
            "telephone_number": "229-242-0825",
            "fax_number": "229-242-0167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALDOSTA CENTER FOR COSMETIC DENTISTRY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-17",
        "last_updated": "2014-09-17",
        "status": "A",
        "authorized_official_last_name": "BYNUM",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-242-0825",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN009147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Valdosta Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.