GOLDEN ISLES ENDODONTICS, LLC (NPI# 1710382007) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710382007 |
| Entity Type | Organization |
| Organization Name | GOLDEN ISLES ENDODONTICS, LLC |
| Other Organization Name | COASTAL ENDODONTICS |
| Practice Address |
1804 Frederica Rd Ste B Saint Simons Island GA 31522-2044 |
| Mailing Address |
Po Box 20067 Saint Simons Island GA 31522-8067 |
| Practice Telephone | 9122682800 |
| Practice Fax Number | 9124349936 |
| Mailing Telephone | 9122682800 |
| Mailing Fax Number | 9124349936 |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2014-10-29 |
| Authorized Official Name | CHRISTOPHER LEA (OWNER) |
| Authorized Official Telephone | 9127565960 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
DN013079 | GA | Dental Providers |
| Other Name | Type Code |
|---|---|
| Coastal Endodontics | Doing Business As Name - Organization |
| Street Address |
1804 FREDERICA RD STE B |
| City | SAINT SIMONS ISLAND |
| State | GA |
| Zip Code | 31522-2044 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982186342 | Matthew Mackinnon Gibbs | Specialist/Technologist | 211 Village Dr, St Simons Is, GA 31522 | 2018-09-02 |
| 1770957433 | Jennifer Herrin, Lpc | Community/Behavioral Health | 400 Main Street, Cottage 1, Saint Simons Island, GA 31522 | 2015-11-18 |
| 1508113002 | Ashley Neal Callicutt | Counselor | 301 Sea Island Road, Suite G, St. Simons Island, GA 31522 | 2012-08-14 |
| 1235414103 | Dana D'andrea Duggan | Psychologist | 283 Redfern Village, St. Simons Island, GA 31522 | 2011-10-11 |
| 1528394848 | Nancy Hodges Bowen | Nurse Practitioner | 7000 Wellness Way, Suite 130, St. Simons Island, GA 31522 | 2009-10-21 |
| 1073763215 | John Arthur Hendry | Dentist | 511 Mallery Street, St. Simons Island, GA 31522 | 2008-09-24 |
| 1770775116 | Randolph M. Stevens | Dentist | Coastal Endodontic Associates, 1804 Frederica Rd., Ste B, St. Simons Island, GA 31522 | 2007-08-09 |
| 1689797383 | Angela C Barnard | Nurse Practitioner | 798 Mallery St Apt 2, Saint Simons Island, GA 31522 | 2007-04-09 |
| 1053493486 | Larry D. Daugherty | Dentist | 124 Island Professional Park, St Simons Island, GA 31522 | 2006-10-19 |
| 1134239460 | Joe Neil Garner | Dentist | 288 Redfern Village, St Simons Island, GA 31522 | 2006-08-30 |
| Find all providers in zip 31522 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437764180 | John O. Green, II, Dds, PC | Dentist | 6126 Prestley Mill Rd Ste J, Douglasville, GA 30134-5624 | 2020-09-10 |
| 1104434232 | Conyers Endodontic Center PC | Dentist | 1920 Highway 20 Se Ste A, Conyers, GA 30013-2048 | 2020-07-15 |
| 1790288678 | Crabapple Endodontics | Dentist | 12385 Crabapple Rd Ste 150, Alpharetta, GA 30004-6357 | 2018-03-16 |
| 1326552522 | Lucas Blaine Connor | Dentist | 3625 Braselton Hwy Ste 101, Dacula, GA 30019-4696 | 2017-11-27 |
| 1346644176 | Liberty Trails Endodontics, LLC | Dentist | 111 E Mills Ave, Hinesville, GA 31313-2616 | 2014-10-22 |
| 1194136929 | Jimmy W. Arnold | Dentist | 152 N Crest Blvd Ste A, Macon, GA 31210-1847 | 2014-05-14 |
| 1629418371 | Young Okeke | Dentist | 6595 Roswell Rd Ste G-3040, Atlanta, GA 30328-3152 | 2013-06-26 |
| 1720342694 | Lake Oconee Endodontics, LLC | Dentist | 112 Harmony Crossing, Suite 1, Eatonton, GA 31024-9536 | 2012-06-26 |
| 1275891541 | Alison Stpaul | Dentist | 1705 Ga-20, Suite 200, Mcdonough, GA 30253 | 2012-04-24 |
| 1780942144 | Marcus Robert Miller | Dentist | 2151 Fountain Dr Ste 206, Snellville, GA 30078-6753 | 2012-04-23 |
| Find all providers with the same taxonomy | ||||
| City | SAINT SIMONS ISLAND |
| Zip Code | 31522 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.