Provider Demographics
NPI:1104035641
Name:HARGROVE, JAMES LAUREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LAUREN
Last Name:HARGROVE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:LAUREN
Other - Last Name:HARGROVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:121 COLLIN REEDS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-7537
Mailing Address - Country:US
Mailing Address - Phone:706-799-0104
Mailing Address - Fax:
Practice Address - Street 1:3246 ATLANTA RD SE STE B
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8231
Practice Address - Country:US
Practice Address - Phone:678-374-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0120641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice