Provider Demographics
NPI:1255969432
Name:BARTON CHAPEL DENTAL GROUP, LLC
Entity type:Organization
Organization Name:BARTON CHAPEL DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANDIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-825-0319
Mailing Address - Street 1:715 HUDGENS CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5101
Mailing Address - Country:US
Mailing Address - Phone:706-825-0319
Mailing Address - Fax:
Practice Address - Street 1:2755 BARTON CHAPEL ROAD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906
Practice Address - Country:US
Practice Address - Phone:706-790-9179
Practice Address - Fax:706-790-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty