Provider Demographics
NPI:1073769857
Name:HARGETT, EDWIN S III (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:S
Last Name:HARGETT
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CARL VINSON PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5815
Mailing Address - Country:US
Mailing Address - Phone:478-922-4922
Mailing Address - Fax:478-929-5292
Practice Address - Street 1:229 CARL VINSON PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5815
Practice Address - Country:US
Practice Address - Phone:478-922-4922
Practice Address - Fax:478-929-5292
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist