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General NPI Number Information
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NPI Number | 1962507079
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Entity Type | Individual
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Provider Name | CRAIG T AJMO DDS
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 294 ELLER RD
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City | ELLIJAY
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State | GA
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Zip | 30536-6109
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Country | US
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Telephone | 941-920-6212
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Fax | 727-784-7383
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Provider Business Mailing Address
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Address Line | 294 ELLER RD
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City | ELLIJAY
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State | GA
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Zip | 30536-6109
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Country | US
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Telephone | 941-920-6212
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Fax | 727-784-7383
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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 | 8918
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9398
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License Number State | GA
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