Alexander Bannout, DDS – General Practice Dentistry

Key facts

NPI: 1255419446
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: DN013382 (GA)
Practice address: 130 Canal St
Suite 204
Pooler, GA 31322-4085
Phone: (912) 748-5868
Fax: (912) 748-6778
NPI assigned: Nov 2, 2006
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Alexander Bannout DDS, PC General Practice Dentistry · Pooler, GA · NPI 1982917522

NPD (past) GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
DN013382	GA	MD	General Practice Dentistry
2901019341	MI	MD	General Practice Dentistry

Practice roles

Organization	Specialty	Status	New patients
Alexander Bannout DDS, PC	General Practice	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	DN013382	GA	Yes
General Practice Dentistry	1223G0001X	2901019341	MI

Addresses

Primary practice location

130 Canal St
Suite 204
Pooler, GA 31322-4085

Mailing address

130 Canal St
Suite 204
Pooler, GA 31322-4085
Phone (912) 748-5868

Other providers in Pooler, GA

All providers in Pooler, GA · General Practice Dentistry in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.