NPIMap

Organization Active NPI

Providence Dental LLC

  • General Practice Dentistry
  • Macon, GA
National Provider Identifier
1295189595
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN013536 Issued in GA
Legal business name
PROVIDENCE DENTAL LLC
Practice address
225 N Macon St
Macon, GA 31210-6562
Phone
(478) 733-0857
Fax
(478) 254-5709
NPI assigned
Apr 22, 2016
Last updated
Jul 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Dr. Paul Jason Mann, DMDNPI 1447458856
Title
Owner
Phone
(478) 733-0857

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 SINGLE SPECIALTY GROUP 1223G0001X DN013536 GA Primary

Addresses

Primary practice location

225 N Macon St
Macon, GA 31210-6562

Mailing address

225 N Macon St
Macon, GA 31210-6562
Phone (478) 733-0857

National Provider Directory

National Provider Directory

Locations

225 N Macon St
Macon, GA 31210
Phone (478) 733-0857

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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": "1461283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1295189595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N MACON ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312106562",
            "telephone_number": "478-733-0857",
            "fax_number": "478-254-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N MACON ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312106562",
            "telephone_number": "478-733-0857",
            "fax_number": "478-254-5709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-22",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-733-0857",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.