Active NPI
Regina Mar, D.D.S.
- Dentist
- Fort Gordon, GA
National Provider Identifier
1558645648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE 60245431
- Practice address
- 228 E Hospital Rd
Fort Gordon Dentac
Fort Gordon, GA 30905-6011 - Phone
- (706) 787-5102
- NPI assigned
- Oct 6, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE 60245431 | WA | Primary |
Addresses
Primary practice location
228 E Hospital Rd
Fort Gordon Dentac
Fort Gordon, GA 30905-6011
Mailing address
228 E Hospital Rd
Fort Gordon Dentac
Fort Gordon, GA 30905-6011
Phone (706) 787-5102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE 60245431 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429142400000",
"number": "1558645648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "228 E HOSPITAL RD",
"address_2": "FORT GORDON DENTAC",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "309056011",
"telephone_number": "706-787-5102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "228 E HOSPITAL RD",
"address_2": "FORT GORDON DENTAC",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "309056011",
"telephone_number": "706-787-5102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAR",
"first_name": "REGINA",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-06",
"last_updated": "2015-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE 60245431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gordon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.