| Augusta Smiles Youth Dentistry, Pc | |
|
1631 Gordon Hwy Suite #22 Augusta GA 30906-2292 | |
| (706) 790-9302 | |
| (706) 790-9303 |
| Full Name | Augusta Smiles Youth Dentistry, Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1631 Gordon Hwy, Augusta, Georgia |
| Authorized Official Name and Position | Jenell Stump (DIRECTOR, LICENSING & CREDENTIALING) |
| Authorized Official Contact | 7067909302 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Augusta Smiles Youth Dentistry, Pc 1631 Gordon Hwy Ste 22 Augusta GA 30906-2230 Ph: (706) 790-9302 | Augusta Smiles Youth Dentistry, Pc 1631 Gordon Hwy Suite #22 Augusta GA 30906-2292 Ph: (706) 790-9302 |
| NPI Number | 1033184643 |
|---|---|
| Provider Enumeration Date | 02/18/2006 |
| Last Update Date | 03/26/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033184643 | NPI | - | NPPES |
| 1770568 | Other | GA | UNITED CONCORDIA |
| 302137931A | Medicaid | GA | |
| ZAG978 | Medicaid | SC | |
| 539114 | Other | GA | AVESIS GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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