Provider Demographics
NPI:1811019706
Name:AGUERO, ALFRED ERNEST (DMD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:ERNEST
Last Name:AGUERO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2666
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-2666
Mailing Address - Country:US
Mailing Address - Phone:229-985-6499
Mailing Address - Fax:229-985-6936
Practice Address - Street 1:1932 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6524
Practice Address - Country:US
Practice Address - Phone:229-985-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0108681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics