Active NPI
Joseph Victor Dufresne, D.D.S.
- General Practice Dentistry
- Morrow, GA
National Provider Identifier
1740202837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9036
- Practice address
- 6612 Exchange PL
Suite B
Morrow, GA 30260-2358 - Phone
- (770) 968-1115
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9036 | GA | Primary |
Addresses
Primary practice location
6612 Exchange PL
Suite B
Morrow, GA 30260-2358
Mailing address
80 Lodge Pole TRL
Mineral Bluff, GA 30559-3244
Phone (404) 310-2456
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150714002350 | GA | Order and Referring Only - Oral Surgery | 6800109224 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1036 | GA | MD | Addiction (Substance Use Disorder) Counselor |
| 9036 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740202837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 LODGE POLE TRL",
"city": "MINERAL BLUFF",
"state": "GA",
"postal_code": "305593244",
"telephone_number": "404-310-2456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6612 EXCHANGE PL",
"address_2": "SUITE B",
"city": "MORROW",
"state": "GA",
"postal_code": "302602358",
"telephone_number": "770-968-1115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUFRESNE",
"first_name": "JOSEPH",
"middle_name": "VICTOR",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "9036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morrow, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.