| Dentrust, P.c. | |
|
201 3rd Ave Bldg 38200 Fort Gordon GA 30905-5904 | |
| (267) 927-5000 | |
| Not Available |
| Full Name | Dentrust, P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 201 3rd Ave Bldg 38200, Fort Gordon, Georgia |
| Authorized Official Name and Position | Amanda Anne Clark (DIRECTOR OF CREDENTIALING) |
| Authorized Official Contact | 2679275000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dentrust, P.c. 1221 Vinewood Dr Seffner FL 33584-4829 Ph: (813) 451-4503 | Dentrust, P.c. 201 3rd Ave Bldg 38200 Fort Gordon GA 30905-5904 Ph: (267) 927-5000 |
| NPI Number | 1609541945 |
|---|---|
| Provider Enumeration Date | 08/10/2021 |
| Last Update Date | 08/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609541945 | NPI | - | NPPES |
| DN014353 | Other | GA | DR.CAPLINS GA LIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |