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General NPI Number Information
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NPI Number | 1588013999
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Entity Type | Individual
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Provider Name | JUSTIN RAGAN DMD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 2562 E ELM ST
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City | WRIGHTSVILLE
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State | GA
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Zip | 31096-2002
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Country | US
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Telephone | 478-864-7127
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Fax | 478-986-3253
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Provider Business Mailing Address
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Address Line | PO BOX 436
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City | WRIGHTSVILLE
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State | GA
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Zip | 31096-0436
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Country | US
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Telephone | 478-864-7127
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Fax | 478-986-3253
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN015165
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License Number State | GA
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