TOWNE LAKE DENTAL GROUP, LLC (NPI# 1053696781) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053696781 |
| Entity Type | Organization |
| Organization Name | TOWNE LAKE DENTAL GROUP, LLC |
| Practice Address |
125 Southern Junction Blvd Suite 701 Pooler GA 31322-2214 |
| Practice Telephone | 9123304545 |
| Mailing Telephone | 9123304545 |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2011-10-13 |
| Authorized Official Name | DR. BRIAN BEAUDREAU (OWNER/DENTIST) |
| Authorized Official Telephone | 9123304545 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
09617 | GA | Dental Providers |
| Street Address |
125 SOUTHERN JUNCTION BLVD SUITE 701 |
| City | POOLER |
| State | GA |
| Zip Code | 31322-2214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548595234 | Shannon Leigh Jernigan | Occupational Therapist | 125 Southern Junction Blvd, Pooler, GA 31322-2214 | 2009-10-14 |
| 1306386024 | Heather Finn | Physical Therapy Assistant | 125 Southern Junction Blvd, Pooler, GA 31322-2214 | 2017-02-28 |
| 1619311255 | Debbie Campolo | Physical Therapist | 125 Southern Junction Blvd, Pooler, GA 31322-2214 | 2013-04-25 |
| 1457794190 | Colin Trester Strub | Dentist | 125 Southern Junction Blvd, Suite 701, Pooler, GA 31322-2214 | 2013-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427518745 | Quinate Pharmacy LLC | Pharmacy | 1557 Pooler Pkwy, Suite 400, Pooler, GA 31322 | 2019-03-22 |
| 1396202495 | Rucker Holdings | Durable Medical Equipment & Medical Supplies | 210 Grand Central Blvd, Pooler, GA 31322 | 2019-02-25 |
| 1306301841 | Altamaha Dme, Inc | Durable Medical Equipment & Medical Supplies | 1557 Pooler Parkway, Suite 300, Pooler, GA 31322 | 2019-02-08 |
| 1750859351 | Bombery Chiropractic LLC | Chiropractor | 122 Canal St. Ste 109, Pooler, GA 31322 | 2018-11-13 |
| 1407347891 | Georgia Dental Professionals, PC | Dentist | 2140 Pooler Pkwy, Pooler, GA 31322 | 2018-05-22 |
| 1730685439 | Monali Patel | Optometrist | 276 Pooler Pkwy Ste B, Pooler, GA 31322 | 2018-04-02 |
| 1144747023 | Publix Super Markers, Inc | Durable Medical Equipment & Medical Supplies | 101 Blue Moon Crossing, Pooler, GA 31322 | 2017-08-23 |
| 1063932408 | The Range Physical Therapy, LLC | Clinic/Center | 10801 County Line Rd, Madison, AL 31322 | 2017-06-27 |
| 1285154427 | Pooler Physical Therapy LLC | Clinic/Center | 101 Shepherd Way, Pooler, GA 31322 | 2017-06-20 |
| 1578009130 | Georgia Cvs Pharmacy L.l.c | Durable Medical Equipment & Medical Supplies | 500 Pooler Pkwy, Pooler, GA 31322 | 2017-01-06 |
| Find all providers in zip 31322 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407347891 | Georgia Dental Professionals, PC | Dentist | 2140 Pooler Pkwy, Pooler, GA 31322 | 2018-05-22 |
| 1760937668 | Gamble Dentalsmart, PC | Dentist | 1034 Us Highway 80 W, Pooler, GA 31322-2114 | 2016-08-20 |
| 1114304540 | Gamble Dentalsmart PC | Dentist | 1034 Highway 80, Pooler, GA 31322 | 2015-05-06 |
| 1396135216 | Georgia Dental Professionals, PC | Dentist | 155 Trader Way, Pooler, GA 31322 | 2015-01-30 |
| 1811013402 | Julia K Howard | Dentist | 91 Brighton Woods Dr, Pooler, GA 31322-2141 | 2007-03-22 |
| 1255419446 | Alexander Bannout | Dentist | 130 Canal St, Suite 204, Pooler, GA 31322-4085 | 2006-11-02 |
| 1164498507 | Shana K Herring | Dentist | 143 Canal St Ste 400, Suite #2, Pooler, GA 31322-6016 | 2006-02-26 |
| 1477048155 | Dimple Jayantilal Patel | Dentist | 276 Pooler Pkwy Ste A, Pooler, GA 31322-5163 | 2018-06-26 |
| 1457794190 | Colin Trester Strub | Dentist | 125 Southern Junction Blvd, Suite 701, Pooler, GA 31322-2214 | 2013-04-11 |
| 1982917522 | Alexander Bannout Dds, PC | Dentist | 130 Canal St, Suite 204, Pooler, GA 31322-4085 | 2010-07-25 |
| Find all providers in POOLER | ||||
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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.