DOUGLAS P BETHONEY, DMD — NPI 1609897958 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in BRANDON, FL)

CMS-1500 Box 24J / 33a • NPI

1609897958

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

1223E0200X

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

625 EICHENFELD DR, BRANDON, FL, 33511-5908

✓ 9-Digit EDI 837 ZIP+4 (33511-5908)

Practice Phone & Referral Fax

(813) 654-3636

Fax: (813) 651-4984

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1609897958 (DOUGLAS P BETHONEY, DMD) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1609897958` (NPI-1 Individual Practitioner)
Provider / Legal Name	DOUGLAS P BETHONEY, DMD
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223E0200X` (Dentist, Endodontics)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	625 EICHENFELD DR, BRANDON, FL, 33511-5908
Practice Telephone / Fax	Tel: (813) 654-3636 \| Fax: (813) 651-4984
Administrative Mailing Address	421 ISLEBAY DR, APOLLO BEACH, FL, 33572-3332
Enumeration & Last Sync	Enumerated: 2006-07-22 \| CMS Record Updated: 2015-02-19

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

625 EICHENFELD DR, BRANDON, FL, 33511-5908

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Plain-English Taxonomy & CMS Crosswalk (1223E0200X)

What Does Taxonomy Code 1223E0200X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223E0200X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (DOUGLAS P BETHONEY, DMD)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1223E0200X` — Dentist, Endodontics Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: FL \| License: `DN15106` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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DOUGLAS P BETHONEY, DMD (NPI #1609897958)