Healthcare Provider Details

I. General information

NPI: 1346920428
Provider Name (Legal Business Name): NADA RIAD ABOUSORRIEH BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-0001
US

IV. Provider business mailing address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-0001
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2371
  • Fax: 706-721-6778
Mailing address:
  • Phone: 706-721-2371
  • Fax: 706-721-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDNF000484
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: