Active NPI
Ted Oley Oellerich, DMD
- Dentist
- Hephzibah, GA
National Provider Identifier
1336211317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 010818
- Practice address
- 2357 Hwy 88
Hephzibah, GA 30815 - Phone
- (706) 592-9551
- Fax
- (706) 592-9556
- NPI assigned
- Nov 14, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 010818 | GA | Primary |
Addresses
Primary practice location
2357 Hwy 88
Hephzibah, GA 30815
Mailing address
PO Box 263
2357 Georgia Highway 88
Hephzibah, GA 30815
Phone (706) 592-9551
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 |
|---|---|---|---|---|
| I20150717002379 | GA | Order and Referring Only - Dentist | 6406169580 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010818 | GA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Liza D. Spratling, LLC | Past | Accepting new patients |
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.
-
- General Practice Dentistry
- Hephzibah, GA
- NPI 1164340816
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336211317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 263",
"address_2": "2357 GEORGIA HIGHWAY 88",
"city": "HEPHZIBAH",
"state": "GA",
"postal_code": "30815",
"telephone_number": "706-592-9551",
"fax_number": "706-592-9556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2357 HWY 88",
"city": "HEPHZIBAH",
"state": "GA",
"postal_code": "30815",
"telephone_number": "706-592-9551",
"fax_number": "706-592-9556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OELLERICH",
"first_name": "TED",
"middle_name": "OLEY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "010818",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hephzibah, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.