Healthcare Provider Details

I. General information

NPI: 1114532934
Provider Name (Legal Business Name): ASHTON GRAHAM SHORT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 02/01/2026
Certification Date: 02/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HARMON AVE STE 200
FORT STEWART GA
31314-5641
US

IV. Provider business mailing address

1061 HARMON AVE STE 200
FORT STEWART GA
31314-5641
US

V. Phone/Fax

Practice location:
  • Phone: 571-802-0376
  • Fax:
Mailing address:
  • Phone: 571-802-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN123936
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61095165
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: