NPIMap

Organization Active NPI

Bridgeport River Dental PC

  • General Practice Dentistry
  • Augusta, GA
National Provider Identifier
1346898293
Registry record updated Sep 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BRIDGEPORT RIVER DENTAL PC
Practice address
1631 Gordon Hwy Ste 22
Augusta, GA 30906-2230
Phone
(706) 790-9302
Fax
(706) 739-4706
NPI assigned
Sep 3, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2019

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

Authorized official

Name
Michelle Jacomino
Title
Director of Payor Relations
Phone
(770) 916-9000

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dental AnesthesiologyGroup: 193200000X MULTI-SPECIALTY GROUP 1223D0004X
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X

Addresses

Primary practice location

1631 Gordon Hwy Ste 22
Augusta, GA 30906-2230

Mailing address

1090 Northchase Pkwy SE Ste 150
Marietta, GA 30067-6407
Phone (770) 916-9000

Other practice location 1

1536 Eisenhower Pkwy
Macon, GA 31206-3130
Phone (478) 781-4333

Other practice location 2

2127 E Victory Dr # A
Savannah, GA 31404-3917
Phone (912) 443-6013

National Provider Directory

National Provider Directory

Locations

1631 Gordon Hwy
Ste 22
Augusta, GA 30906
Phone (706) 790-9302

1536 Eisenhower Pkwy
Macon, GA 31206
Phone (478) 781-4333

2127 E Victory Dr
#A
Savannah, GA 31404
Phone (912) 443-6013

Practitioners & affiliated clinicians

Practitioners 7

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": "1567468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567468800000",
    "number": "1346898293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 NORTHCHASE PKWY SE STE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676407",
            "telephone_number": "770-916-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 GORDON HWY STE 22",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309062230",
            "telephone_number": "706-790-9302",
            "fax_number": "706-739-4706"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1536 Eisenhower Pkwy",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312063130",
            "country_code": "US",
            "telephone_number": "478-781-4333",
            "fax_number": "478-239-5679",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2127 E Victory Dr # A",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314043917",
            "country_code": "US",
            "telephone_number": "912-443-6013",
            "fax_number": "912-642-4145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRIDGEPORT RIVER DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-03",
        "last_updated": "2019-09-03",
        "status": "A",
        "authorized_official_last_name": "JACOMINO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR OF PAYOR RELATIONS",
        "authorized_official_telephone_number": "770-916-9000"
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; 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.