Dexter P Inniss, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN012791 Issued in GA

Practice address

Corner of RT N12 and N7
Fort Defiance, AZ 86504-0649

Phone

(770) 760-7566

NPI assigned

Dec 1, 2006

Last updated

Mar 5, 2025By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gentle Touch Dental

  • General Practice Dentistry
  • Conyers, GA
  • NPI 1609994136
  NPD (past)

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1629146469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 649",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865040649",
            "telephone_number": "928-729-8000",
            "fax_number": "928-729-3355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CORNER OF RT N12 AND N7",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865040649",
            "telephone_number": "770-760-7566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INNISS",
        "first_name": "DEXTER",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "569997178A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mason Hunt, RRT
• Kristoffer D Hunter
• Daniel J Huyser, LPC
• Michael Ihsaan, MD MPH
• Heather Ayn Indelicato, PSY.D
• Jermal Jackson, RRT
• Kathryn Elizabeth Jacques, MPT
• Jacquelyn James, CRNA
• Lilia Janzen-Trotsyuk
• Gregory Jarrin, MD

• General Practice Dentistry in Fort Defiance, AZ
• Providers in Fort Defiance, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.