Dogwood Pediatric Dentistry of Pooler, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

DOGWOOD PEDIATRIC DENTISTRY OF POOLER, LLC

Practice address

100 Blue Moon Xing Ste 105
Pooler, GA 31322-9809

Phone

(912) 661-1391

NPI assigned

Jun 6, 2022

Last updated

Jun 16, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Karen Stevens

Title

Office Manager

Phone

(912) 661-1391

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Phillip Brandon Gordon, DMD

  • Pediatric Dentistry
  • Statesboro, GA
  • NPI 1942833595
  NPD (past)

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

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655337600000",
    "number": "1396474458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 COMMONWEALTH AVE",
            "city": "PORT WENTWORTH",
            "state": "GA",
            "postal_code": "314071916",
            "telephone_number": "912-661-1391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BLUE MOON XING STE 105",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313229809",
            "telephone_number": "912-661-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOGWOOD PEDIATRIC DENTISTRY OF POOLER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-06",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "912-661-1391"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine K Dickens, M.D.
• Eva Dittrich, PSYD
• Divine Keepers Homecare Services LLC
• Tawanda C Dixon, MA CCC-SLP
• Beth A Dodds, LMT
• Skyler John Doherty, LMT
• Hannah Douglas
• Dr Angie Lyn PT
• Melissa Carder Dransfield, SLP
• Kathryn E Dresser, APRN

• Pediatric Dentistry in Pooler, GA
• Providers in Pooler, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; 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.