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General NPI Number Information
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NPI Number | 1457541781
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Entity Type | Organization
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Legal Business Name | AU DENTAL ASSOCIATES
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 1430 JOHN WESLEY GILBERT DRIVE
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City | AUGUSTA
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State | GA
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Zip | 30912-1001
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Country | US
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Telephone | 706-721-2371
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Fax |
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Provider Business Mailing Address
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Address Line | 1430 JOHN WESLEY GILBERT DRIVE GC-1012
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-721-7913
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Fax | 706-721-6778
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Authorized Official
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Title or Position | ASSOCIATE DEAN, FINANCE / BUSINESS
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Name | DARRELL GENTRY
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Credential |
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Telephone | 706-721-2103
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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 | 000179
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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