David Motoban, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN122469 Issued in GA

Practice address

117 Pavilion Pkwy
Fayetteville, GA 30214-7732

Phone

(770) 953-6975

NPI assigned

Aug 16, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

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

{
    "created_epoch": "1629072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629072000000",
    "number": "1669147161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 PAVILION PKWY STE 15C",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 PAVILION PKWY",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147732",
            "telephone_number": "770-953-6975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOTOBAN",
        "first_name": "DAVID",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-16",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN122469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "FayettevilleSmilesDentistry.com",
            "affiliation": "N",
            "address_1": "117 Pavilion Pkwy",
            "city": "Fayetteville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302147732",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Diane Blair Morris, RDN, LD
• Kenneth Morris
• Annie Quinn Morrissey, M.D.
• Maria Morrow
• Morton Smiles LLC
• Shilene Moultrie-Johnson, ED.D
• William Matthew Mowery, PTA
• Patricia H. Mowry, M.ED., LPC
• Kenya Moye-Clayton, M.A., CCC-SLP
• MRD&Ca Solutions

• 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 Aug 16, 2021; 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.