Healthcare Provider Details

I. General information

NPI: 1154205813
Provider Name (Legal Business Name): JOSHUA VENTENILLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE STOP A
FORT BRAGG NC
28310-0315
US

IV. Provider business mailing address

2817 ROCK MERRITT AVE STOP A
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14605
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number14226300-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: