Provider Demographics
NPI:1598203374
Name:NORTH AUGUSTA DENTAL CARE, LLC
Entity type:Organization
Organization Name:NORTH AUGUSTA DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:USRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-279-1880
Mailing Address - Street 1:504 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3709
Mailing Address - Country:US
Mailing Address - Phone:803-279-1880
Mailing Address - Fax:803-279-1884
Practice Address - Street 1:504 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3709
Practice Address - Country:US
Practice Address - Phone:803-279-1880
Practice Address - Fax:803-279-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8165122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty