Healthcare Provider Details

I. General information

NPI: 1316015563
Provider Name (Legal Business Name): AUGUSTA ORTHODONTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 BLUE RIDGE DRIVE
EVANS GA
30809-3604
US

IV. Provider business mailing address

580 BLUE RIDGE DRIVE
EVANS GA
30809-3604
US

V. Phone/Fax

Practice location:
  • Phone: 706-855-9903
  • Fax: 706-855-9861
Mailing address:
  • Phone: 706-855-9903
  • Fax: 706-855-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number06988
License Number StateGA

VIII. Authorized Official

Name: DR. JAMES DENNIS METTS
Title or Position: OWNER
Credential: DDS
Phone: 706-855-9903