Provider Demographics
NPI:1194988337
Name:PARENTE, JUSTIN MATTHEW (DMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MATTHEW
Last Name:PARENTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 LANEY WALKER BLVD
Mailing Address - Street 2:AD2901 SCHOOL OF DENTISTRY
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1459 LANEY WALKER BLVD
Practice Address - Street 2:AD2901 SCHOOL OF DENTISTRY
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-1244
Practice Address - Country:US
Practice Address - Phone:706-721-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist