MIDWAY FAMILY DENTAL (NPI# 1780043000) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780043000 |
| Entity Type | Organization |
| Organization Name | MIDWAY FAMILY DENTAL |
| Other Organization Name | RB JACKSON, III DMD |
| Practice Address |
1718 N Coastal Hwy Midway GA 31320-3415 |
| Mailing Address |
Po Box 134 Midway GA 31320-0134 |
| Practice Telephone | 9128802288 |
| Practice Fax Number | 9128802110 |
| Mailing Telephone | 9128802288 |
| Mailing Fax Number | 9128802110 |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2016-02-15 |
| Authorized Official Name | ROLLIN B JACKSON (OWNER) |
| Authorized Official Telephone | 9128802288 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
014447 | GA | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
014574 | GA | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
013091 | GA | Dental Providers |
| Other Name | Type Code |
|---|---|
| RB Jackson, III DMD | Doing Business As Name - Organization |
| Street Address |
1718 N COASTAL HWY |
| City | MIDWAY |
| State | GA |
| Zip Code | 31320-3415 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306988571 | Rollin B Jackson IIi | Dentist | 1718 N Coastal Hwy, Midway, GA 31320-3415 | 2007-02-13 |
| 1811404494 | Chet Edward Bundy | Dental Hygienist | 1718 N Coastal Hwy, Midway, GA 31320-3415 | 2018-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407123557 | Woodlands Healthcare & Rehab LLC | Skilled Nursing Facility | 625 Coastal Highway 17 N, Midway, GA 31320 | 2011-11-17 |
| 1467638221 | Trinity Healthcare Recruiting Corp | Contractor | 242 Coastal Hwy Suite 100, Prime Care Medical Bldg, Midway, GA 31320 | 2008-01-11 |
| 1043437502 | Noel C. Luis-smith | Physical Therapist | Us Highway 17 North, Woodlands Health Care LLC, Midway, GA 31320 | 2007-04-19 |
| 1245392224 | Coastal Drug Company LLC | Pharmacy | 204 Butler St, Midway, GA 31320 | 2006-12-15 |
| 1285643320 | Betty Jane Long | Pharmacist | 204 Butler Ave, Midway, GA 31320 | 2006-08-07 |
| 1255302733 | Woodland Health Care LLC | Skilled Nursing Facility | 652 N Coastal Hwy 17, Midway, GA 31320 | 2006-01-31 |
| 1811986003 | Traiana Daciana Pacurar | Internal Medicine | 586 Islands Highway, Midway, GA 31320 | 2005-10-19 |
| 1003391459 | Liberty Orthopaedic Associates | Orthopaedic Surgery | 586 Islands Highway, Midway, GA 31320 | 2018-10-02 |
| 1093214041 | Hospital Authority of Liberty County | General Practice | 586 Islands Highway, Midway, GA 31320 | 2018-02-06 |
| 1124144068 | Coastal Discount Pharmacy | Durable Medical Equipment & Medical Supplies | 204 Butler St, Midway, GA 31320 | 2007-03-22 |
| Find all providers in zip 31320 | ||||
| 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 |
|---|---|---|---|---|
| 1225523582 | Justin Paul Pennington | Dentist | 28 Butler St, Midway, GA 31320-4294 | 2018-06-28 |
| 1841649449 | Rachel A Riley | Dentist | 128a E Main St, Midway, KY 40347 | 2016-06-06 |
| 1649674409 | Jerome Scott Kearby | Dentist | 12120 Savage Drive, Midway, TX 75852-3654 | 2014-10-22 |
| 1972841781 | John A. Moore | Dentist | 113 N. Winter St., Midway, KY 40347-0761 | 2013-01-29 |
| 1407187362 | Jack L Brauer | Dentist | 450 Bern Way, Midway, UT 84049 | 2010-01-15 |
| 1306988571 | Rollin B Jackson IIi | Dentist | 1718 N Coastal Hwy, Midway, GA 31320-3415 | 2007-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427659028 | My Emergency Dental Ga, LLC | Dentist | 4811 Lower Roswell Rd Ste 108, Marietta, GA 30068-4345 | 2020-11-02 |
| 1417556630 | Feyishayo Dahunsi | Dentist | 50 Main Street Market Pl Se Ste 500, Cartersville, GA 30121-3312 | 2020-10-19 |
| 1568079143 | Bimala Gharti | Dentist | 7310 Village Creek Trce, Atlanta, GA 30328-6763 | 2020-09-28 |
| 1760098214 | Georgia Dental Professionals, PC | Dentist | 3000 Chapel Hill Rd Ste 104, Douglasville, GA 30135-1841 | 2020-09-21 |
| 1063028769 | Georgia Dental Professionals, PC | Dentist | 3364 Hamilton Mill Rd, Buford, GA 30519-4005 | 2020-09-17 |
| 1306452016 | Georgia Dental Professionals, PC | Dentist | 2680 Highway 34 E Ste A, Newnan, GA 30265-1330 | 2020-09-17 |
| 1720693690 | Georgia Dental Professionals, PC | Dentist | 3625 Browns Bridge Rd Ste 101, Cumming, GA 30028-4198 | 2020-09-09 |
| 1699385062 | Hetal Trivedi | Dentist | 930 Spring St Nw Unit 915-a, Atlanta, GA 30309-3816 | 2020-07-31 |
| 1285242693 | Georgia Dental Professionals, PC | Dentist | 5185 Peachtree Pkwy Ste 201, Norcross, GA 30092-6539 | 2020-07-22 |
| 1770101131 | Fatima Hassan | Dentist | 722 Bonnie Oaks Ln, Evans, GA 30809-6114 | 2020-07-11 |
| 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.