ORAL SURGERY OF WEST AUGUSTA PC; NPI #1538571435

Contact Information

ORAL SURGERY OF WEST AUGUSTA PC

3634 WHEELER RD
AUGUSTA, GA 30909-6518

Phone: 706-860-8228
Fax: 706-860-7222
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Oral & Maxillofacial Surgery	204E00000X	02	Physician/General Surgery

Indicates primary specialty

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NPI Profile & details for ORAL SURGERY OF WEST AUGUSTA PC

NPI # 1538571435

LBN Legal business name ORAL SURGERY OF WEST AUGUSTA PC

Authorized official BORIS SIDOW - (OWNER SURGEON)

Entity Organization

Organization subpart ¹ No

Enumeration date 05/27/2014

Last updated 05/27/2014 - About 12 years ago

Identifiers

GA	License #	DN013478
GA	Medicaid	000056427C
GA	Medicaid	000056438C
GA	Medicaid	111331508B
	Other	000425742	TRICARE ACTIVE DUTY DENTAL PLAN
	Other	000848645	TRICARE ACTIVE DUTY DENTAL PLAN
	Other	002068046	TRICARE ACTIVE DUTY DENTAL PLAN

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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ORAL SURGERY OF WEST AUGUSTA PC

Contact Information

Specialty

Oral & Maxillofacial Surgery

NPI Profile & details for ORAL SURGERY OF WEST AUGUSTA PC

Reviews for ORAL SURGERY OF WEST AUGUSTA PC