BENJAMIN M PRIDEMORE JR. (NPI# 1336153592) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336153592 |
| Entity Type | Individual |
| Full Name | BENJAMIN M PRIDEMORE JR. |
| Credential | DDS |
| Practice Address |
23 John Maddox Dr Nw Rome GA 30165-1413 |
| Practice Telephone | 7062340877 |
| Practice Fax Number | 7062325327 |
| Mailing Telephone | 7062340877 |
| Mailing Fax Number | 7062325327 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
DN007095 | GA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | STATE LICENSE NUMBER | DN007095 | 01 |
| Street Address |
23 JOHN MADDOX DR NW |
| City | ROME |
| State | GA |
| Zip Code | 30165-1413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982900817 | Ryan Jeffery Cox | Dentist | 23 John Maddox Dr Nw, Rome, GA 30165-1413 | 2011-02-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868775 | Heather Bowman | Physical Therapist | 600 Eagle, E Lake Dr, Rome, GA 30165 | 2020-07-13 |
| 1205451101 | Kristopher Nelson | Student in an Organized Health Care Education/Training Program | 4256, 304 Shorter Ave Nw #201, Rome, GA 30165 | 2020-06-16 |
| 1962061457 | Stuart Paul Shaklee | Occupational Therapy Assistant | 1356 Redmond Road, Rome, GA 30165 | 2019-06-10 |
| 1386001055 | Autumn Streetman | Counselor | 6 Mathis Drive, Rome, GA 30165 | 2016-01-26 |
| 1144695784 | Gabrador Milligan | Counselor | 6 Mathis Road, Rome, GA 30165 | 2015-12-08 |
| 1386041952 | Theresa Suits | Registered Nurse | 1 Woodbine Avenue, Rome, GA 30165 | 2014-11-26 |
| 1942561147 | Nicole C. Christian | Clinical Neuropsychologist | 305 Redmond Rd, Rome, GA 30165 | 2012-06-04 |
| 1679832711 | Niki Pareshkumar Bhavsar | Internal Medicine | 3041 Turner Mccall Blvd, Rome, GA 30165 | 2012-05-10 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1033436647 | Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 4 Coosawattee Ave, Rome, GA 30165 | 2010-04-23 |
| Find all providers in zip 30165 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366059396 | Cedar Dental Clinical I, LLC | Dentist | 18 Riverbend Dr Sw Ste 230, Rome, GA 30161-6019 | 2020-09-24 |
| 1710057088 | Joseph Kent Vargo | Dentist | 419 East Second Avenue, Rome, GA 30161 | 2006-11-08 |
| 1871600932 | Richard J Klockowski | Dentist | 306 West Liberty St, Rome, NY 13440-5744 | 2006-08-24 |
| 1790143899 | Foundations Orthodontics LLC | Dentist | 317 Redmond Rd Nw, Rome, GA 30165-1539 | 2016-02-03 |
| 1386087500 | William Bennett | Dentist | 317 Redmond Rd Nw, Rome, GA 30165-1539 | 2013-04-08 |
| 1982900817 | Ryan Jeffery Cox | Dentist | 23 John Maddox Dr Nw, Rome, GA 30165-1413 | 2011-02-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144828765 | Sharma Orthodontics LLC | Dentist | 3535 Roswell Rd Ste 53, Marietta, GA 30062-8828 | 2020-10-15 |
| 1700484094 | Beltway Orthodontics | Dentist | 857 Collier Rd Nw Ste 5a-5b, Atlanta, GA 30318-2532 | 2020-10-09 |
| 1003423039 | Cedar Dental Clinical I, LLC | Dentist | 119 Willow Ln, Mcdonough, GA 30253-6574 | 2020-09-24 |
| 1073120002 | Cedar Dental Clinical I, LLC | Dentist | 494 Booth Rd Ste 1a, Warner Robins, GA 31088-3435 | 2020-09-24 |
| 1942817960 | Cedar Dental Clinical I, LLC | Dentist | 4272 Washington Rd Ste 7a, Evans, GA 30809-3073 | 2020-09-24 |
| 1740897776 | Cedar Dental Clinical I, LLC | Dentist | 3630 Thompson Bridge Rd Ste 18b, Gainesville, GA 30506-1524 | 2020-09-24 |
| 1790392710 | Cedar Dental Clinical I, LLC | Dentist | 6801 Governors Lake Pkwy Ste 290, Peachtree Corners, GA 30071-1136 | 2020-09-24 |
| 1598379679 | Dr. Milan Dhanani PC | Dentist | 1905 Beaver Ruin Rd Ste 175b, Norcross, GA 30071-3837 | 2020-09-04 |
| 1316584758 | Classic City Orthodontics, LLC | Dentist | 1020 Jamestown Blvd Bldg 100, Watkinsville, GA 30677-4131 | 2019-12-04 |
| 1952957714 | Melisa Stewart | Dentist | 5555 Peachtree Dunwoody Rd Ste 301, Atlanta, GA 30342-1712 | 2019-08-16 |
| Find all providers with the same taxonomy | ||||
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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.