Dentrust, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTRUST, P.C.

Doing business as

Dentrust Dental Ft. Stewart

Practice address

112 Vilseck Rd
Ft.Stewart, GA 31315

Phone

(267) 927-5000

NPI assigned

Aug 26, 2021

Last updated

Aug 26, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

DENTRUST PCAs reported in NPPES

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

Authorized official

Name

Amanda Anne Clark

Title

Director of Credentialing

Phone

(267) 927-5000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dentrust Dental Ft. Stewart Doing business as

Electronic endpoints 1

Tax ID family

Dentrust PC3 organizations share this tax ID, including this one

Part of

Dentrust PC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Dentrust, P.C.

  dba DOCS Dental Ft. Gordon

  • General Practice Dentistry
  • Fort Gordon, GA
  • NPI 1609541945
  NPD tax ID
• Dentrust, P.C.

  • Dentist
  • Pipersville, PA
  • NPI 1902994809
  NPD tax ID

Interoperability endpoints

• Direct secure messaging: ft.stewartinfo@docs.health

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

{
    "created_epoch": "1629936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629936000000",
    "number": "1932876950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 VINEWOOD DR",
            "city": "SEFFNER",
            "state": "FL",
            "postal_code": "335844829",
            "telephone_number": "813-451-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 VILSECK RD",
            "city": "FT.STEWART",
            "state": "GA",
            "postal_code": "31315",
            "telephone_number": "267-927-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTRUST, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTRUST PC",
        "enumeration_date": "2021-08-26",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "267-927-5000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR.CAPLIN'S LIC GA",
            "identifier": "DN014535",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ft.Stewartinfo@docs.health",
            "affiliation": "N",
            "address_1": "112 Vilseck Rd",
            "city": "Ft.Stewart",
            "state": "GA",
            "country_code": "US",
            "postal_code": "31315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Dentrust Dental Ft. Stewart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; 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.