BRIDGEPORT RIVER DENTAL PC (NPI# 1346898293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346898293 |
| Entity Type | Organization |
| Organization Name | BRIDGEPORT RIVER DENTAL PC |
| Practice Address |
1631 Gordon Hwy Ste 22 Augusta GA 30906-2230 |
| Mailing Address |
1090 Northchase Pkwy Se Ste 150 Marietta GA 30067-6407 |
| Practice Telephone | 7067909302 |
| Practice Fax Number | 7067394706 |
| Mailing Telephone | 7709169000 |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2019-09-03 |
| Authorized Official Name | MICHELLE JACOMINO (DIRECTOR OF PAYOR RELATIONS) |
| Authorized Official Telephone | 7709169000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223D0004X |
Dentist Specialization: Dentist Anesthesiologist |
Dental Providers | ||
| N | 1223E0200X |
Dentist Specialization: Endodontics |
Dental Providers | ||
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers | ||
| N | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers | ||
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers | ||
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1536 Eisenhower Pkwy, Macon, GA 312063130 | 4787814333 | 4782395679 |
| 2127 E Victory Dr # A, Savannah, GA 314043917 | 9124436013 | 9126424145 |
| Street Address |
1631 GORDON HWY STE 22 |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30906-2230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730633959 | Carol A. Patel | Dentist | 1631 Gordon Hwy Ste 22, Augusta, GA 30906-2230 | 2016-08-04 |
| 1356993331 | Jessica A George | Dentist | 1631 Gordon Hwy Ste 22, Augusta, GA 30906-2230 | 2019-07-10 |
| 1871079376 | La'quinta Sharelle Elim | Dentist | 1631 Gordon Hwy Ste 22, Augusta, GA 30906-2230 | 2018-07-17 |
| 1790213700 | Phuong Quynh Ngoc Spicer | Dentist | 1631 Gordon Hwy Ste 22, Augusta, GA 30906-2230 | 2017-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255969432 | Barton Chapel Dental Group, LLC | Dentist | 2755 Barton Chapel Road, Augusta, GA 30906 | 2020-04-01 |
| 1255897419 | Pediatric Mobility Innovations | Durable Medical Equipment & Medical Supplies | 3114 Augusta Tech Drive Suite 404, Augusta, GA 30906 | 2019-02-13 |
| 1023539731 | Kristy Lee Gibbs | Registered Nurse | 3421 Mike Padgett Hwy Bldg C, Augusta, GA 30906 | 2017-07-03 |
| 1194186031 | Clifton Nane Williams | Counselor | 3230 Hampton Circle, Augusta, GA 30906 | 2016-03-18 |
| 1376929661 | Catherine A. Ganzy | Social Worker | 3405 Mike Padgett Highway; Building 201, East Central Regional Hosptial, Augusta, GA 30906 | 2015-08-10 |
| 1962810358 | Fatemeh Azadeh Paziraei | Dentist | 1631 Gordon Highway, Augusta Smiles Youth Dentistry, Augusta, GA 30906 | 2014-07-29 |
| 1568809770 | Brandon Jennings | Occupational Therapy Assistant | 2388 Old Mcduffie Rd, Augusta, GA 30906 | 2013-05-29 |
| 1811266646 | Eddie P Johnson IIi, Dmd, PC | Preferred Provider Organization | 2755 Barton Chapel Rd, Augusta, GA 30906 | 2011-12-23 |
| 1366739021 | Kerensa A Cooks | Registered Nurse | 3421 Mike Padgett Highway, Serenity Behavioral Health Systems, Augusta, GA 30906 | 2011-07-01 |
| 1265737423 | Pidcock Chiropractic, Inc. | Chiropractor | 3028 Peach Orchard Rd., Augusta, GA 30906 | 2011-01-20 |
| Find all providers in zip 30906 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275158156 | Mary Cameron Elizabeth Robert | Dentist | 3226 Washington Rd, Augusta, GA 30907 | 2020-06-16 |
| 1255969432 | Barton Chapel Dental Group, LLC | Dentist | 2755 Barton Chapel Road, Augusta, GA 30906 | 2020-04-01 |
| 1730633959 | Carol A. Patel | Dentist | 1631 Gordon Hwy Ste 22, Augusta, GA 30906-2230 | 2016-08-04 |
| 1477938629 | Alie Kraft | Dentist | 1430 John Wesley Gilbert Dr Augusta University, Augusta, GA 30912-5660 | 2015-07-29 |
| 1982013116 | Jeffrey Steed | Dentist | Dental College of Georgia 1430 John Wesley Gilbert Dr, Augusta, GA 30912 | 2014-08-13 |
| 1619380144 | Nicole Anne Hasenfus | Dentist | 169 Water St, Augusta, ME 04330-4607 | 2014-06-02 |
| 1275898900 | Dyess Parkway Dental, LLC | Dentist | 4045 Jimmie Dyess Pkwy Ste 103, Augusta, GA 30909-9492 | 2012-07-09 |
| 1578862777 | Jonathan L Bullard | Dentist | 3702 Washington Rd., Augusta, GA 30907-2848 | 2011-03-28 |
| 1811205040 | Jason Hamel | Dentist | 94 Western Ave Ste 1, Augusta, ME 04330-7269 | 2010-09-22 |
| 1659686806 | Alan F Myers | Dentist | 1014 Northwood Rd, Suite A, Augusta, GA 30909-2312 | 2010-08-12 |
| Find all providers in AUGUSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.