MEDICARE: T. BARRETT TROTTER, DMD, PC

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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	7979	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	792021	OTHER	GA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1558486761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T. BARRETT TROTTER, DMD, PC

Provider Business Mailing Address
First Line	:	525 PLEASANT HOME RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-3525
Country	:	US
Telephone Number	:	706-860-2442
Fax Number	:	706-650-3197

Provider Business Practice Location Address
First Line	:	525 PLEASANT HOME RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-3525
Country	:	US
Telephone Number	:	706-860-2442
Fax Number	:	706-650-3197

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. TOBIN BARRETT TROTTER
Credential	:	DMD
Telephone Number	:	706-860-2442

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/22/2020

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