Provider Demographics
NPI:1962611368
Name:WILLARD, BETH ANN (CDA)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:WILLARD
Suffix:
Gender:F
Credentials:CDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3741
Mailing Address - Country:US
Mailing Address - Phone:706-721-2716
Mailing Address - Fax:706-721-1893
Practice Address - Street 1:1459 LANEY WALKER BLVD
Practice Address - Street 2:AD2802
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0002
Practice Address - Country:US
Practice Address - Phone:706-721-2716
Practice Address - Fax:706-721-1893
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant