Provider Demographics
NPI:1245249457
Name:PUGH, BRIAN ALEXANDER (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALEXANDER
Last Name:PUGH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3625 BRASELTON HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1014
Mailing Address - Country:US
Mailing Address - Phone:770-614-9467
Mailing Address - Fax:770-614-9468
Practice Address - Street 1:3625 BRASELTON HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1014
Practice Address - Country:US
Practice Address - Phone:770-614-9467
Practice Address - Fax:770-614-9468
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129361223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics