Justin William Bordlemay, DMD
Individual provider Active NPI Periodontics · Richmond Hill, GA
NPI 1376522722 · NPPES record last updated Jun 22, 2023
Key facts
- NPI
- 1376522722
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- DN013841 (GA)
- Practice address
- 10055 Ford Ave Ste 3C
Richmond Hill, GA 31324-3972 - Phone
- (912) 445-5311
- Fax
- (912) 445-0738
- NPI assigned
- Jan 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160322001093 | GA | Order and Referring Only - Oral Surgery |
9638476427 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN013841 | GA | MD | Periodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics |
1223P0300X | DN013841 | GA | Yes |
Addresses
Primary practice location
10055 Ford Ave Ste 3C
Richmond Hill, GA 31324-3972
Mailing address
PO Box 1885
Richmond Hill, GA 31324-1885
Phone (706) 627-5358
Other providers in Richmond Hill, GA
- Margaret Ellen Blossman
- Kathy Bolton
- Luke Thomas Boon
- Lyndsey Boone
- Catherine Thamer Bordlemay
- Bost Physical Therapy, LLC
- Christine Louise Bost
- Ricki Botsford
- Tanetra Denaye Bowens
- Tanner Boyle
All providers in Richmond Hill, GA · Periodontics in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.