MEDICARE: DR. JOSHUA VENTENILLA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14605	NC
2	122300000X	Dentist	14226300-9926	UT

General Provider Information

NPI Number	:	1154205813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA VENTENILLA DDS

Provider Business Mailing Address
First Line	:	2817 ROCK MERRITT AVE
Second Line	:	STOP A
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVE
Second Line	:	STOP A
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-0315
Country	:	US
Telephone Number	:	910-907-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	05/18/2026

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