Provider Demographics
NPI:1548223753
Name:AUGUSTA REGIONAL DENTAL CLINIC
Entity Type:Organization
Organization Name:AUGUSTA REGIONAL DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-332-5619
Mailing Address - Street 1:342 MULE ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2256
Mailing Address - Country:US
Mailing Address - Phone:540-332-5619
Mailing Address - Fax:540-332-5622
Practice Address - Street 1:342 MULE ACADEMY RD
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2256
Practice Address - Country:US
Practice Address - Phone:540-332-5619
Practice Address - Fax:540-332-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty