NPIMap

Organization Active NPI

Liberty Trails Endodontics, LLC

  • Endodontics
  • Hinesville, GA
National Provider Identifier
1346644176
Registry record updated Oct 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
DN013079 Issued in GA
Legal business name
LIBERTY TRAILS ENDODONTICS, LLC
Practice address
111 E Mills Ave
Hinesville, GA 31313-2616
Phone
(912) 463-4405
Fax
(912) 463-4939
NPI assigned
Oct 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2014

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

Authorized official

Name
Christopher Lea, DDSNPI 1295783298
Title
Owner
Phone
(912) 756-5960

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
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X DN013079 GA Primary

Addresses

Primary practice location

111 E Mills Ave
Hinesville, GA 31313-2616

Mailing address

111 E Mills Ave
Hinesville, GA 31313-2616
Phone (912) 463-4405

Other names 1

  • Coastal Endodontics Doing business as

National Provider Directory

National Provider Directory

Locations

111 E Mills Ave
Hinesville, GA 31313
Phone (912) 463-4405

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413936000000",
    "number": "1346644176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E MILLS AVE",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313132616",
            "telephone_number": "912-463-4405",
            "fax_number": "912-463-4939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E MILLS AVE",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313132616",
            "telephone_number": "912-463-4405",
            "fax_number": "912-463-4939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY TRAILS ENDODONTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-22",
        "last_updated": "2014-10-22",
        "status": "A",
        "authorized_official_last_name": "LEA",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-756-5960",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "GA",
            "license": "DN013079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Endodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hinesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2014; 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.