Colin Trester Strub, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN01426 Issued in GA

Practice address

125 Southern Junction Blvd
Suite 701
Pooler, GA 31322-2214

Phone

(912) 330-4545

Fax

(888) 629-3621

NPI assigned

Apr 11, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Towne Lake Dental Group, LLC

  • General Practice Dentistry
  • Pooler, GA
  • NPI 1053696781
  NPD (past)

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373328000000",
    "number": "1457794190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2155 BENTON BLVD",
            "address_2": "APT 15303",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313221991",
            "telephone_number": "920-207-3988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 SOUTHERN JUNCTION BLVD",
            "address_2": "SUITE 701",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313222214",
            "telephone_number": "912-330-4545",
            "fax_number": "888-629-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STRUB",
        "first_name": "COLIN",
        "middle_name": "TRESTER",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-11",
        "last_updated": "2013-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN01426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deja Sterling
• Lauren Stevenson
• Leewood Brawner Still, O.D.
• Kassidy Schyler Oneil Street
• Laura Strom, DO
• Heidi Sulick, PTA
• Haleigh Summerall
• Samantha Paige Summerlin, PAC
• Keishawna Summers
• Suns Up International, Inc

• General Practice Dentistry in Pooler, GA
• Providers in Pooler, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; 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.