Maridith G De Jesus, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN123034 Issued in GA

Practice address

3525 Busbee Dr NW
Kennesaw, GA 30144-5677

Phone

(678) 836-2115

NPI assigned

May 22, 2007

Last updated

Aug 9, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Practice roles

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

• Coast Dental P.a.

  dba Coast Dental-Zephyrhills

  • Dentist
  • Zephyrhills, FL
  • NPI 1285200519
  NPD (past)
• Coast Dental P.a.

  • Dentist
  • Tampa, FL
  • NPI 1992803860
  NPD (past)

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1821207077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 COALTER WAY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300303321",
            "telephone_number": "973-647-5897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3525 BUSBEE DR NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301445677",
            "telephone_number": "678-836-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE JESUS",
        "first_name": "MARIDITH",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN22274",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN123034",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN2274",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Misty Delaine Davis, OTR
• Rhonda Lou Davis, PH.D.
• Shakyra Davis
• Tammy Davis, COTA
• Kirti Daya, RPH
• Diana De Loe
• Toni De Loura, OTR/L
• Daylin De Zayas Gonzalez
• Jenny R Deforeest, CRNA
• Melanie Michelle Defusco, PHARMD

• General Practice Dentistry in Kennesaw, GA
• Providers in Kennesaw, 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 Aug 9, 2023; 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.