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General NPI Number Information
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NPI Number | 1760668404
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Entity Type | Organization
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Legal Business Name | VARNELL GAINES DMD PC
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 1930 HIGHLAND AVE STE C
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City | AUGUSTA
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State | GA
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Zip | 30904-7801
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Country | US
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Telephone | 706-738-0482
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 FLAGLER RD
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City | AUGUSTA
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State | GA
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Zip | 30909-9573
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Country | US
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Telephone | 706-860-9454
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. VARNELL GAINES SR.
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Credential |
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Telephone | 706-738-0482
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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 | DN008943
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License Number State | GA
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