Provider Demographics
NPI:1659321735
Name:DEBORAH A. ASHCRAFT, D.M.D.,P.C.
Entity Type:Organization
Organization Name:DEBORAH A. ASHCRAFT, D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-279-9901
Mailing Address - Street 1:460 W MARTINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3106
Mailing Address - Country:US
Mailing Address - Phone:803-279-9901
Mailing Address - Fax:803-279-9215
Practice Address - Street 1:460 W MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3106
Practice Address - Country:US
Practice Address - Phone:803-279-9901
Practice Address - Fax:803-279-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3364-4611223P0221X
GA113181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00707165BMedicaid
SCZA9849Medicaid