Provider Demographics
NPI:1932330164
Name:DAMRON, JUSTIN BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:BRIAN
Last Name:DAMRON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4418
Mailing Address - Country:US
Mailing Address - Phone:912-352-2324
Mailing Address - Fax:912-354-0935
Practice Address - Street 1:4815 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4418
Practice Address - Country:US
Practice Address - Phone:912-352-2324
Practice Address - Fax:912-354-0935
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0145711223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136282BMedicaid
GA003136282CMedicaid