Provider Demographics
NPI:1518407907
Name:AUGUSTA SMILECARE PC
Entity Type:Organization
Organization Name:AUGUSTA SMILECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPA
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:USRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-722-5337
Mailing Address - Street 1:4200 COLUMBIA ROAD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907
Mailing Address - Country:US
Mailing Address - Phone:706-868-1322
Mailing Address - Fax:706-650-1061
Practice Address - Street 1:4200 COLUMBIA ROAD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-868-1322
Practice Address - Fax:706-650-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty