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General NPI Number Information
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NPI Number | 1013379163
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Entity Type | Organization
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Legal Business Name | MUSCOGEE DENTISTRY, P.C.
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Dates
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Enumeration Date | 03/27/2016
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Last Update Date | 03/27/2016
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Provider Practice Location Address
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Address Line | 3619 CALVIN DR
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City | COLUMBUS
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State | GA
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Zip | 31904-7915
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Country | US
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Telephone | 706-940-0528
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Fax | 706-940-0571
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Provider Business Mailing Address
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Address Line | 3619 CALVIN DR
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City | COLUMBUS
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State | GA
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Zip | 31904-7915
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Country | US
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Telephone | 706-940-0528
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Fax | 706-940-0571
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREA SHAWNKI TRICE
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Credential | D.M.D
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Telephone | 770-880-9680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN013193
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License Number State | GA
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