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General NPI Number Information
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NPI Number | 1811019706
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Entity Type | Individual
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Provider Name | ALFRED ERNEST AGUERO DMD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1932 S MAIN ST
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City | MOULTRIE
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State | GA
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Zip | 31768-6524
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Country | US
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Telephone | 229-985-6499
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2666
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City | MOULTRIE
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State | GA
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Zip | 31776-2666
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Country | US
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Telephone | 229-985-6499
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Fax | 229-985-6936
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 010868
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License Number State | GA
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