Healthcare Provider Details

I. General information

NPI: 1154629855
Provider Name (Legal Business Name): EMMANUEL C NGOH DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 WHEELER RD
AUGUSTA GA
30909
US

IV. Provider business mailing address

3636 WHEELER RD
AUGUSTA GA
30909
US

V. Phone/Fax

Practice location:
  • Phone: 706-869-9117
  • Fax: 706-869-8836
Mailing address:
  • Phone: 706-869-9117
  • Fax: 706-869-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberLCB20010026537
License Number StateGA

VIII. Authorized Official

Name: DR. EMMANUEL C NGOH
Title or Position: OWNER
Credential: DMD
Phone: 706-869-9117