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General NPI Number Information
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NPI Number | 1255969432
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Entity Type | Organization
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Legal Business Name | BARTON CHAPEL DENTAL GROUP, LLC
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 2755 BARTON CHAPEL ROAD
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City | AUGUSTA
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State | GA
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Zip | 30906
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Country | US
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Telephone | 706-790-9179
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Fax | 706-790-3408
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Provider Business Mailing Address
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Address Line | 715 HUDGENS CT
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City | EVANS
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State | GA
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Zip | 30809-5101
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Country | US
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Telephone | 706-825-0319
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERRENCE L VANDIVER
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Credential | DMD
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Telephone | 706-825-0319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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