NPIMap

Organization Active NPI

Au Dental Associates

  • Dentist
  • Augusta, GA
National Provider Identifier
1457541781
Registry record updated Mar 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
AU DENTAL ASSOCIATES
Practice address
1430 John Wesley Gilbert Drive
Augusta, GA 30912-1001
Phone
(706) 721-2371
NPI assigned
Aug 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Janice Ethridge
Title
Credentialing Specialist
Phone
(706) 721-7913

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 000179 GA
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1430 John Wesley Gilbert Drive
Augusta, GA 30912-1001

Mailing address

1430 John Wesley Gilbert Drive GC-1012
Augusta, GA 30912-0004
Phone (706) 721-7913

Other practice location 1

750 Hazel St
Macon, GA 31201-6856
Phone (478) 334-5050

Other names 1

  • AU Dental Associates Dental College of GA Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040520000734 GA Part B Supplier - Clinic/Group Practice 7810988607 Receives reassigned benefits from 20 practitioners
Practice locations: Augusta, GA; Macon, GA
O20200226002248 GA DME Supplier - OcularistDME Supplier - Prosthetic PersonnelDME Supplier - Other 7810988607 Practice locations: Augusta, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Au Dental Associates1430 John W Gilbert Dr, Augusta, GA 30912-0001(706) 721-2371 Contracture Treatment Devices: Dynamic Splint|Orthoses: Custom Fabricated|Breast Prostheses and/or Accessories|Facial Prostheses|Ocular Prostheses|Somatic Prostheses|Limb Prostheses Accepts assignmentParticipating since Dec 31, 1998

National Provider Directory

National Provider Directory

Locations

1430 John Wesley
Augusta, GA 30912

1430 John Wesley Gilbert Dr Gc1024
Augusta, GA 30912

1430 John W Gilbert Dr
Augusta, GA 30912

1120 15th St
#1012
Augusta, GA 30912

1459 Laney Walker Blvd
Augusta, GA 30912
Phone (706) 721-2423

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 78

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 78

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773360000000",
    "number": "1457541781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 JOHN WESLEY GILBERT DRIVE GC-1012",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120004",
            "telephone_number": "706-721-7913",
            "fax_number": "706-721-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 JOHN WESLEY GILBERT DRIVE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309121001",
            "telephone_number": "706-721-2371"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 Hazel St",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312016856",
            "country_code": "US",
            "telephone_number": "478-334-5050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AU DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-01",
        "last_updated": "2026-03-13",
        "certification_date": "2026-03-13",
        "status": "A",
        "authorized_official_last_name": "ETHRIDGE",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "706-721-7913"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "000179",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AU Dental Associates Dental College of GA",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "AU Dental Associates Dental College of GA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.