McGovern Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN013714 Issued in GA

Legal business name

MCGOVERN DENTAL, LLC

Practice address

1370 Gordon St W
Douglas, GA 31533-3432

Phone

(912) 384-1306

Fax

(912) 384-1308

NPI assigned

Aug 30, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Justin McGovern, D.M.DNPI 1366606519

Title

Owner

Phone

(912) 384-1306

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin McGovern, D.M.D.

  • Dentist
  • Douglas, GA
  • NPI 1366606519
  NPD (past) Authorized official

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

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314662400000",
    "number": "1972884344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1370 GORDON ST W",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315333432",
            "telephone_number": "912-384-1306",
            "fax_number": "912-384-1308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 GORDON ST W",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315333432",
            "telephone_number": "912-384-1306",
            "fax_number": "912-384-1308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCGOVERN DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-30",
        "last_updated": "2011-08-30",
        "status": "A",
        "authorized_official_last_name": "MCGOVERN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-384-1306",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003106996A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Kate McBee, APRN
• Leigh Anna McBride, NP-C
• Taylor McCarty, MT013456
• Ashley Simmons McCrary, PHARMD
• Teresa Lynn McElroy, M ED CCC/SLP
• Justin McGovern, D.M.D.
• Daren McKean, DC
• Brandy S McKeown, OTR/L, CLT-LANA
• Melissa Miller McKinney, PSY.D., LPC
• Charles Dylan McLean

• General Practice Dentistry in Douglas, GA
• Providers in Douglas, 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 30, 2011; 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.