Bldg 38801 Academic Dr, Ste B&c, Suite B & C, Ft Gordon, GA 30905
Phone
(706) 787-7050
Listed under
Prosthodontists
NPI
1649750142
NPI status
Active in the NPPES registry
Provider type
Individual provider
Registered specialty (self-reported taxonomy)
Prosthodontics (1223P0700X)
Credentials listed
DDS
License number on NPI record
0401416179 (VA)
NPI first issued
Aug 15, 2018
NPI record last updated
Jun 27, 2023
NPI 1649750142 is active in the federal NPPES registry (CMS) with Prosthodontics, an ADA-recognized dental specialty, as its primary taxonomy; license 0401416179 (VA) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-09-30.
What these registry facts mean
The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an individual clinician. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. Prosthodontists specialize in restoring and replacing teeth: crowns, bridges, dentures and the teeth that go on top of implants, including full-arch fixed bridges. Dentists who are not specialists can also place implants; the specialty here is the one the provider registered as primary.
Checking credentials: the specialty shown is the one this provider registered with the NPI system. Your state dental board's license lookup confirms the license, and the American Board of Prosthodontics, the American Board of Oral and Maxillofacial Surgery and the American Board of Periodontology each list their board-certified members.