MEDICARE: DR. CRAIG T AJMO DDS

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	1223G0001X	General Practice Dentistry	8918	FL
2	1223G0001X	General Practice Dentistry	9398	GA

General Provider Information

NPI Number	:	1962507079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG T AJMO DDS

Provider Business Mailing Address
First Line	:	294 ELLER RD
Second Line	:
City	:	ELLIJAY
State	:	GA
Zip	:	30536-6109
Country	:	US
Telephone Number	:	941-920-6212
Fax Number	:	727-784-7383

Provider Business Practice Location Address
First Line	:	294 ELLER RD
Second Line	:
City	:	ELLIJAY
State	:	GA
Zip	:	30536-6109
Country	:	US
Telephone Number	:	941-920-6212
Fax Number	:	727-784-7383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/20/2016

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