Genesis Dental Group Smiles on 11TH LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GENESIS DENTAL GROUP SMILES ON 11TH LLC

Practice address

1010 W 11TH St
Panama City, FL 32401-2042

Phone

(850) 763-3622

NPI assigned

Jun 20, 2017

Organization subpart

No

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

Authorized official

Name

Susan Stewart

Title

Manager

Phone

(334) 676-2320

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497916800000",
    "number": "1629598750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 ZELDA CT",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361062607",
            "telephone_number": "334-676-2320",
            "fax_number": "334-593-2724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 W 11TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012042",
            "telephone_number": "850-763-3622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS DENTAL GROUP SMILES ON 11TH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-20",
        "last_updated": "2017-06-20",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "334-676-2320"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• GD FL Cove PLLC
• GD FL Forest Park PLLC
• Linda Jolene Gemsch, ARNP
• General Surgery of Panama City Inc
• Generations Wellness
• Genesis Partners LLC
• Genesis Rehab Services
• Genoa Healthcare LLC
• George G Tracy MD LLC
• George J Walters DDS PA

• General Practice Dentistry in Panama City, FL
• Providers in Panama City, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2017; 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.