Provider Demographics
NPI:1962507079
Name:AJMO, CRAIG T (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:T
Last Name:AJMO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 ELLER RD
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30536-6109
Mailing Address - Country:US
Mailing Address - Phone:941-920-6212
Mailing Address - Fax:727-784-7383
Practice Address - Street 1:294 ELLER RD
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30536-6109
Practice Address - Country:US
Practice Address - Phone:941-920-6212
Practice Address - Fax:727-784-7383
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89181223G0001X
GA93981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice