Active NPI
Harry Nick Bobotis, DMD
- Dentist
- Fort Stewart, GA
National Provider Identifier
1215981352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN011989
- Practice address
- 112 Vilseck Road
BLDG 419-2
Fort Stewart, GA 31315 - Phone
- (912) 257-7056
- Fax
- (912) 257-7055
- NPI assigned
- May 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3490 | SC | |
| Dentist | 122300000X | DN011989 | GA | Primary |
Addresses
Primary practice location
112 Vilseck Road
BLDG 419-2
Fort Stewart, GA 31315
Mailing address
112 Vilseck Road
BLDG 419-2
Fort Stewart, GA 31315
Phone (912) 257-7056
Other practice location 1
5-C Cleveland Court
Greenville, SC 29607
Phone (864) 271-1220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Z34909 | Medicaid | SC |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210115000348 | GA | Order and Referring Only - Dentist | 5991096489 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3490 | SC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1215981352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 VILSECK ROAD",
"address_2": "BLDG 419-2",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "31315",
"telephone_number": "912-257-7056",
"fax_number": "912-257-7055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 VILSECK ROAD",
"address_2": "BLDG 419-2",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "31315",
"telephone_number": "912-257-7056",
"fax_number": "912-257-7055"
}
],
"practiceLocations": [
{
"address_1": "5-C Cleveland Court",
"address_purpose": "LOCATION",
"city": "Greenville",
"state": "SC",
"postal_code": "29607",
"country_code": "US",
"telephone_number": "864-271-1220",
"fax_number": "864-271-7267",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BOBOTIS",
"first_name": "HARRY",
"middle_name": "NICK",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-22",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "3490",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN011989",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Z34909",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Stewart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.