Healthcare Provider Details

I. General information

NPI: 1811726904
Provider Name (Legal Business Name): JOHNCROSS CHIDUBEM NWADIJE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3456 WRIGHTSBORO RD
AUGUSTA GA
30909-2678
US

IV. Provider business mailing address

1252 KNOX AVE
NORTH AUGUSTA SC
29841-4055
US

V. Phone/Fax

Practice location:
  • Phone: 706-251-7917
  • Fax:
Mailing address:
  • Phone: 803-426-5039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN124359
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDGD.11493.GD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: