NPIMap

Organization Active NPI

Monticello Family Dentistry

  • General Practice Dentistry
  • Monticello, GA
National Provider Identifier
1679340368
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MONTICELLO FAMILY DENTISTRY
Practice address
458 W Washington St
Monticello, GA 31064-1368
Phone
(706) 468-6394
Fax
(706) 468-8113
NPI assigned
Dec 4, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Authorized official

Name
Tyler Lipham, DMDNPI 1821583782
Title
Owner/Agent
Phone
(706) 468-6394

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

458 W Washington St
Monticello, GA 31064-1368

Mailing address

458 W Washington St
Monticello, GA 31064-1368
Phone (706) 468-6394

Other identifiers 1

IdentifierTypeStateIssuer
003236116CMedicaidGA

National Provider Directory

National Provider Directory

Locations

458 W Washington St
Monticello, GA 31064
Phone (706) 468-6394

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1679340368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "458 W WASHINGTON ST",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310641368",
            "telephone_number": "706-468-6394",
            "fax_number": "706-468-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "458 W WASHINGTON ST",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310641368",
            "telephone_number": "706-468-6394",
            "fax_number": "706-468-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTICELLO FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-04",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "LIPHAM",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "OWNER/AGENT",
        "authorized_official_telephone_number": "706-468-6394",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003236116C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; 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.