Provider Demographics
NPI:1386650836
Name:AUGUSTA DENTAL ASSOCIATES,LLC
Entity Type:Organization
Organization Name:AUGUSTA DENTAL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:QUENTIN
Authorized Official - Last Name:SHERMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-920-0581
Mailing Address - Street 1:2947 WALTON WAY EXT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3827
Mailing Address - Country:US
Mailing Address - Phone:706-738-6516
Mailing Address - Fax:706-262-6518
Practice Address - Street 1:2947 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-3827
Practice Address - Country:US
Practice Address - Phone:706-738-6516
Practice Address - Fax:706-262-6518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty