O'Tisha Julianna Preston, D.D.S,

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

FP1505708 Issued in GA

Practice address

5656 Jonesboro Rd Ste 103
Morrow, GA 30260-3853

Phone

(863) 860-7876

NPI assigned

Jul 12, 2009

Sex

Female

Sole proprietor

Yes

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

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

{
    "created_epoch": "1247356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247356800000",
    "number": "1790914729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5656 JONESBORO RD STE 103",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "302603853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5656 JONESBORO RD STE 103",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "302603853",
            "telephone_number": "863-860-7876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESTON",
        "first_name": "O'TISHA",
        "middle_name": "JULIANNA",
        "name_prefix": "Dr.",
        "credential": "D.D.S,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-12",
        "last_updated": "2009-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "FP1505708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Morrow, GA
• Providers in Morrow, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2009; 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.