Provider Demographics
NPI:1316990120
Name:GUINN, JOHN W III (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:GUINN
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:GC-1024
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-9633
Mailing Address - Fax:706-723-0266
Practice Address - Street 1:1430 JOHN WESLEY GILBERT DRIVE
Practice Address - Street 2:GC-1024
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-1001
Practice Address - Country:US
Practice Address - Phone:706-721-9633
Practice Address - Fax:706-723-0266
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0085041223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZG8504Medicaid
GA000802689AMedicaid