Provider Demographics
NPI:1558486761
Name:T. BARRETT TROTTER, DMD, PC
Entity Type:Organization
Organization Name:T. BARRETT TROTTER, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBIN
Authorized Official - Middle Name:BARRETT
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-860-2442
Mailing Address - Street 1:525 PLEASANT HOME RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3525
Mailing Address - Country:US
Mailing Address - Phone:706-860-2442
Mailing Address - Fax:706-650-3197
Practice Address - Street 1:525 PLEASANT HOME RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3525
Practice Address - Country:US
Practice Address - Phone:706-860-2442
Practice Address - Fax:706-650-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA792021OtherUNITED CONCORDIA