Provider Demographics
NPI:1184209660
Name:AUGUSTA ADVANCED DENTISTRY LLC
Entity Type:Organization
Organization Name:AUGUSTA ADVANCED DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-860-0575
Mailing Address - Street 1:2926 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-6530
Mailing Address - Country:US
Mailing Address - Phone:706-860-0575
Mailing Address - Fax:706-860-4186
Practice Address - Street 1:2926 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-6530
Practice Address - Country:US
Practice Address - Phone:706-860-0575
Practice Address - Fax:706-860-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental