NPIMap

Organization Active NPI

Augusta Dental Associates, LLC

  • General Practice Dentistry
  • Augusta, GA
National Provider Identifier
1619901808
Registry record updated Jul 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
012377 Issued in GA
Legal business name
AUGUSTA DENTAL ASSOCIATES, LLC
Practice address
1218 Augusta West Parkway
Augusta, GA 30909-1808
Phone
(706) 860-0518
Fax
(706) 860-4902
NPI assigned
Jul 11, 2006
Last updated
Jul 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2023

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

Authorized official

Name
Dr. Christopher Michael Moldovan, DMDNPI 1265467542
Title
Owner/Dentist
Phone
(706) 860-0518

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 012377 GA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 8815 GA

Addresses

Primary practice location

1218 Augusta West Parkway
Augusta, GA 30909-1808

Mailing address

1218 Augusta West Parkway
Augusta, GA 30909-1808
Phone (706) 860-0518

Other identifiers 2

IdentifierTypeStateIssuer
00922655AMedicaidGA
00137948BMedicaidGA

Other names 1

  • Michael O. Vernon, DMD, PC Former legal business name

National Provider Directory

National Provider Directory

Locations

1218 Augusta West Pkwy
Augusta, GA 30909
Phone (706) 860-0518

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689292800000",
    "number": "1619901808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1218 AUGUSTA WEST PARKWAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309091808",
            "telephone_number": "706-860-0518",
            "fax_number": "706-860-4902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 AUGUSTA WEST PARKWAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309091808",
            "telephone_number": "706-860-0518",
            "fax_number": "706-860-4902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTA DENTAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A",
        "authorized_official_last_name": "MOLDOVAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "706-860-0518",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "012377",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "8815",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00922655A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00137948B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael O. Vernon, DMD, PC",
            "code": "4",
            "type": "Former Legal Business 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 Jul 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.