Provider Demographics
NPI:1154629855
Name:EMMANUEL C NGOH DMD PC
Entity Type:Organization
Organization Name:EMMANUEL C NGOH DMD PC
Other - Org Name:AUGUSTA ENDODONTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:NGOH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-869-9117
Mailing Address - Street 1:3636 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909
Mailing Address - Country:US
Mailing Address - Phone:706-869-9117
Mailing Address - Fax:706-869-8836
Practice Address - Street 1:3636 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909
Practice Address - Country:US
Practice Address - Phone:706-869-9117
Practice Address - Fax:706-869-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCB200100265371223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty