Healthcare Provider Details

I. General information

NPI: 1548223753
Provider Name (Legal Business Name): AUGUSTA REGIONAL DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 MULE ACADEMY RD
FISHERSVILLE VA
22939-2256
US

IV. Provider business mailing address

342 MULE ACADEMY RD
FISHERSVILLE VA
22939-2256
US

V. Phone/Fax

Practice location:
  • Phone: 540-332-5619
  • Fax: 540-332-5622
Mailing address:
  • Phone: 540-332-5619
  • Fax: 540-332-5622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT LITTEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 540-332-5619