Dr Damaris Bastian Gen.Dent. LLC

Primary specialty

DentistTaxonomy code 122300000X

License

5087 Issued in LA

Legal business name

DR DAMARIS BASTIAN GEN.DENT. LLC

Practice address

101 Devant St Ste 404
Fayetteville, GA 30214-2713

Phone

(678) 884-5352

NPI assigned

May 8, 2007

Organization subpart

No

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

Authorized official

Name

Damaris Derece Bastian, DDSNPI 1518218353

Title

Owner

Phone

(678) 884-5352

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Damaris Derece Bastian, D.D.S.

  • General Practice Dentistry
  • Fayetteville, GA
  • NPI 1518218353
  NPD Authorized official

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636329600000",
    "number": "1609089002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 DEVANT ST STE 404",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302142713",
            "telephone_number": "678-884-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DEVANT ST STE 404",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302142713",
            "telephone_number": "678-884-5352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR DAMARIS BASTIAN GEN.DENT. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A",
        "authorized_official_last_name": "BASTIAN",
        "authorized_official_first_name": "DAMARIS",
        "authorized_official_middle_name": "DERECE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-884-5352",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "LA",
            "license": "5087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1850870",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "4334104830",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Edward Donohue II, PHYSICIAN ASSISTANT
• George Dorton III
• Claire Douglas
• Doute Counseling Services
• Jemal Doute, LMFT
• Daniel G Draper II
• Dream Builders Counseling
• Sanaa Drew, RBT
• Angela Duan
• Tracy Dudley, NP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; 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.