Ford Avenue Family Dentistry, LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

FORD AVENUE FAMILY DENTISTRY, LLC

Practice address

10230 Ford Ave
Richmond Hill, GA 31324-8854

Phone

(912) 756-2936

NPI assigned

Oct 25, 2018

Last updated

Oct 25, 2018By 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

Dr. Ray Linton Wallace III, DMDNPI 1427440957

Title

Dentist

Phone

(912) 695-2801

Specialties & licenses 1

Addresses

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.

• Ray Linton Wallace III, D.M.D.

  • Student in an Organized Health Care Education/Training Program
  • Augusta, GA
  • NPI 1427440957
  Authorized official Same address or phone

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

{
    "created_epoch": "1540425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540425600000",
    "number": "1619444981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10230 FORD AVE",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313248854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10230 FORD AVE",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313248854",
            "telephone_number": "912-756-2936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORD AVENUE FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-25",
        "last_updated": "2018-10-25",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "RAY",
        "authorized_official_middle_name": "LINTON",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "912-695-2801",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Farthing, M.S., CCC-SLP
• Katie Beth Fields, RBT
• Rebecca Fisher, SLP
• Kimberly Fitton, PTA
• Helue Flores
• Kimberly Ford, RBT
• Yesenia Forero
• Denisse Foster, LPN
• Grant Allan Foster, M.D.
• Priscilla Butler Fraser, NP

• Dentist in Richmond Hill, GA
• Providers in Richmond Hill, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2018; 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.