Provider Demographics
NPI:1891119533
Name:KEVIN L RAGSDALE, D.D.S., P.C.
Entity Type:Organization
Organization Name:KEVIN L RAGSDALE, D.D.S., P.C.
Other - Org Name:KEVIN L. RAGSDALE, D.D.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAGSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-275-6631
Mailing Address - Street 1:1501 BROADRICK DR
Mailing Address - Street 2:STE 2
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3014
Mailing Address - Country:US
Mailing Address - Phone:706-275-6631
Mailing Address - Fax:706-226-4899
Practice Address - Street 1:1501 BROADRICK DR
Practice Address - Street 2:STE 2
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3014
Practice Address - Country:US
Practice Address - Phone:706-275-6631
Practice Address - Fax:706-226-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0101651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty