| Center For Pediatric Dentistry, Llc | |
|
1243 Augusta West Pkwy Augusta GA 30909-1807 | |
| (706) 855-8989 | |
| (706) 855-0321 |
| Full Name | Center For Pediatric Dentistry, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1243 Augusta West Pkwy, Augusta, Georgia |
| Authorized Official Name and Position | Mary Shirley (ADMINISTRATOR) |
| Authorized Official Contact | 7068558989 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Pediatric Dentistry, Llc 1243 Augusta West Pkwy Augusta GA 30909-1807 Ph: (706) 855-8989 | Center For Pediatric Dentistry, Llc 1243 Augusta West Pkwy Augusta GA 30909-1807 Ph: (706) 855-8989 |
| NPI Number | 1164490918 |
|---|---|
| Provider Enumeration Date | 03/09/2006 |
| Last Update Date | 01/18/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164490918 | NPI | - | NPPES |
| 945328611A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 11680 (Georgia) | Primary |
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