Provider Demographics
NPI:1508117987
Name:GAINES, JOIDAZ JERMAINE
Entity Type:Individual
Prefix:DR
First Name:JOIDAZ
Middle Name:JERMAINE
Last Name:GAINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 HIGHLAND AVE
Mailing Address - Street 2:SUITE #C
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-7800
Mailing Address - Country:US
Mailing Address - Phone:706-738-0482
Mailing Address - Fax:
Practice Address - Street 1:1930 HIGHLAND AVE
Practice Address - Street 2:SUITE #C
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-7800
Practice Address - Country:US
Practice Address - Phone:706-738-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0143041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice