Athens Dental Group LLC
Dentist, General Practice in Watkinsville, GA. Organization (NPI-2).
NPI number1992499693
StatusActive
Last updated in NPPESJun 6, 2023
Details
- NPI
- 1992499693
- Entity type
- Organization (NPI-2)
- Legal business name
- Athens Dental Group LLC
- Organization subpart
- No
- Enumeration date
- Jun 6, 2023
- Certification date
- May 30, 2023
- Last updated
- Jun 6, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Aesthetic Dental Associates (Doing Business As)
Practice location
1520 Jennings Mill Rd Ste AWatkinsville, GA 30677-7308
Phone 706-353-1958
Mailing address
1520 Jennings Mill Rd Ste AWatkinsville, GA 30677-7308
Phone 706-353-1958
Authorized official
Brant Sandifer
Owner
7063531958
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