Stacie Bentley, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN015465 Issued in GA

Practice address

674 Lake Joy Road
Kathleen, GA 31047

Phone

(217) 540-5100

NPI assigned

Jul 11, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Georgia Dental Professionals, PC

  • General Practice Dentistry
  • Kathleen, GA
  • NPI 1679091805
  NPD (past)

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

{
    "created_epoch": "1499731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1669994786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "674 LAKE JOY ROAD",
            "city": "KATHLEEN",
            "state": "GA",
            "postal_code": "31047",
            "telephone_number": "217-540-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "674 LAKE JOY ROAD",
            "city": "KATHLEEN",
            "state": "GA",
            "postal_code": "31047",
            "telephone_number": "217-540-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENTLEY",
        "first_name": "STACIE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-11",
        "last_updated": "2022-07-21",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN015465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Kathleen, GA
• Providers in Kathleen, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.