Dentrust, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTRUST, P.C.

Practice address

201 3Rd Ave BLDG 38200
Fort Gordon, GA 30905-5904

Phone

(267) 927-5000

NPI assigned

Aug 10, 2021

Organization subpart

Yes

Parent organization

DENTRUST PCAs reported in NPPES

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

Authorized official

Name

Amanda Anne Clark

Title

Director of Credentialing

Phone

(267) 927-5000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DOCS Dental Ft. Gordon Doing business as

Electronic endpoints 1

Tax ID family

Dentrust PC3 organizations share this tax ID, including this one

Part of

Dentrust PC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Dentrust, P.C.

  • General Practice Dentistry
  • Ft.Stewart, GA
  • NPI 1932876950
  NPD tax ID
• Dentrust, P.C.

  • Dentist
  • Pipersville, PA
  • NPI 1902994809
  NPD tax ID

Locations

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

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1609541945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 VINEWOOD DR",
            "city": "SEFFNER",
            "state": "FL",
            "postal_code": "335844829",
            "telephone_number": "813-451-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 3RD AVE BLDG 38200",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055904",
            "telephone_number": "267-927-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTRUST, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTRUST PC",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "267-927-5000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR.CAPLINS GA LIC",
            "identifier": "DN014353",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ft.gordoninfo@docs.health",
            "affiliation": "N",
            "address_1": "201 3rd Ave Bldg 38200",
            "city": "Fort Gordon",
            "state": "GA",
            "country_code": "US",
            "postal_code": "309055904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "DOCS Dental Ft. Gordon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marvin Dees, MD
• Adam Luis Delgado, MD
• Matthew James Dellen, MD
• William J Demsar, DMD
• Tianshuai Deng, DMD
• Department of Defense
• Dung Dinh, MD
• Bryan DO, PHARMD
• Eric Larson Doane, DO
• Ken Marvin Dobbins, PH.D.

• General Practice Dentistry in Fort Gordon, GA
• Providers in Fort Gordon, 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 Aug 10, 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.