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General NPI Number Information
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NPI Number | 1861670143
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Entity Type | Organization
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Legal Business Name | AUGUSTA ORAL SURGERY SPECIALISTS PC
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 3736 WALTON WAY EXT
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City | AUGUSTA
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State | GA
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Zip | 30907-2402
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Country | US
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Telephone | 706-228-3100
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Fax | 706-228-3707
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Provider Business Mailing Address
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Address Line | 3736 WALTON WAY EXT
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City | AUGUSTA
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State | GA
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Zip | 30907-2402
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Country | US
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Telephone | 706-228-3100
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Fax | 706-228-3707
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL C D'ARCO
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Credential | DDS
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Telephone | 706-228-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN011130
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License Number State | GA
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