PBT Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PBT DENTAL LLC

Practice address

590 S Enota Dr NE Ste 2
Gainesville, GA 30501-2433

Phone

(770) 536-4471

Fax

(770) 534-2174

NPI assigned

Jan 18, 2019

Organization subpart

No

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

Authorized official

Name

Victoria Johnson

Title

Cro

Phone

(941) 444-0558

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1366916744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 S ENOTA DR NE STE 2",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 S ENOTA DR NE STE 2",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012433",
            "telephone_number": "770-536-4471",
            "fax_number": "770-534-2174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PBT DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-18",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CRO",
        "authorized_official_telephone_number": "941-444-0558"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Travis Michael Patterson, M.D.
• John David Patton Jr., MD
• Andrea Marie Paul, LCSW
• Larry Jeffrey Payne, M.D.
• Robert Dale Payne, MSPT
• PCP Dental LLC
• PCR-DX, LLC
• Peaceful Hearts Enterprise Inc
• Peachstate Health Management LLC
• Peachtree Childrens Dentistry Gainesville LLC

• Dentist in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; 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.