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NPI Code Detail

MEDICARE: MUSCOGEE DENTISTRY, P.C.

MEDICARE: MUSCOGEE DENTISTRY, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDN013193GA

General Provider Information

NPI Number : 1013379163
Entity Type Code : Organization
Provider Name (Legal Business Name) : MUSCOGEE DENTISTRY, P.C.
Provider Business Mailing Address
First Line : 3619 CALVIN DR
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-7915
Country : US
Telephone Number : 706-940-0528
Fax Number : 706-940-0571
Provider Business Practice Location Address
First Line : 3619 CALVIN DR
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-7915
Country : US
Telephone Number : 706-940-0528
Fax Number : 706-940-0571
Authorized Official
Title or Position : PRESIDENT
Name : DR. ANDREA SHAWNKI TRICE
Credential : D.M.D
Telephone Number : 770-880-9680
Provider Enumeration Date : 03/27/2016
Last Update Date : 03/27/2016

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Directions to “MUSCOGEE DENTISTRY, P.C. ” Practice Location

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