Active NPI
Cynthia S Ditslear, D.D.S
- Dentist
- Grovetown, GA
National Provider Identifier
1235340852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN012691
- Practice address
- 3001 Gordon Hwy
Grovetown, GA 30813-3808 - Phone
- (706) 855-4866
- NPI assigned
- May 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN012691 | GA | Primary |
Addresses
Primary practice location
3001 Gordon Hwy
Grovetown, GA 30813-3808
Mailing address
412 Bakers Ferry TRL
Martinez, GA 30907-4924
Phone (706) 651-0641
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN012691 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235340852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "412 BAKERS FERRY TRL",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309074924",
"telephone_number": "706-651-0641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 GORDON HWY",
"city": "GROVETOWN",
"state": "GA",
"postal_code": "308133808",
"telephone_number": "706-855-4866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DITSLEAR",
"first_name": "CYNTHIA",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN012691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grovetown, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.