Provider Demographics
NPI:1760668404
Name:VARNELL GAINES DMD PC
Entity Type:Organization
Organization Name:VARNELL GAINES DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VARNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:706-738-0482
Mailing Address - Street 1:1708 FLAGLER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9573
Mailing Address - Country:US
Mailing Address - Phone:706-860-9454
Mailing Address - Fax:
Practice Address - Street 1:1930 HIGHLAND AVE STE C
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-7801
Practice Address - Country:US
Practice Address - Phone:706-738-0482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0089431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZAG979Medicaid