Dwayne Bacchus, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN19547 Issued in FL

Practice address

2468 W Brandon Blvd
Brandon, FL 33511-4717

Phone

(813) 257-8318

NPI assigned

Mar 13, 2007

Last updated

Apr 13, 2022By the provider in NPPES

Sex

Male

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 FL

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

Networks

• Freedom Health HMO Network

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.

• Dental Professionals of Illinois, P.C.

  dba North Vermillion Family Dental

  • General Practice Dentistry
  • Danville, IL
  • NPI 1780806034
  NPD (past)
• Lifetime Dental Care of Illinois, PC

  dba Champaign Dental Group

  • General Practice Dentistry
  • Champaign, IL
  • NPI 1376765776
  NPD (past)

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1891828471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2468 W BRANDON BLVD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114717",
            "telephone_number": "813-257-8318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2468 W BRANDON BLVD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114717",
            "telephone_number": "813-257-8318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACCHUS",
        "first_name": "DWAYNE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN19547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Orvil Luis Ayala, MD
• Ahmet Aydin, MD
• Muhammad Ayyaz, M.D.
• Noor Azam, APRN
• Elizabeth Aziz, DO
• Melanie Adora Bachman
• Back to Wellness Chiropractic Inc
• Maylin Badal
• Ashley Bader, RN
• Moaaz Baghal, MD

• Dentist in Brandon, FL
• Providers in Brandon, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.