Provider Demographics
NPI:1144231440
Name:AUGUSTA ASSOCIATES OF ENDODONTICS
Entity Type:Organization
Organization Name:AUGUSTA ASSOCIATES OF ENDODONTICS
Other - Org Name:OCONEE ASSOCIATES OF ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-736-1406
Mailing Address - Street 1:3502 WHEELER ROAD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1824
Mailing Address - Country:US
Mailing Address - Phone:706-736-1406
Mailing Address - Fax:706-721-0706
Practice Address - Street 1:3502 WHEELER ROAD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1824
Practice Address - Country:US
Practice Address - Phone:706-736-1406
Practice Address - Fax:706-721-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA80101223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty