Bridgeport River Dental PC

NPI #1346898293 in Augusta, Georgia

Provider Information

NPI Number: 1346898293
Entity Type: Organization
Organization Name: Bridgeport River Dental PC
Primary Specialty: Dentist - General Practice
Enumeration Date: Sep 3, 2019
Last Updated: Sep 3, 2019

Practice Location

Address: 1631 GORDON HWY STE 22
City: Augusta
State: Georgia
ZIP Code: 30906-2230
Phone: (706) 790-9302

Authorized Official

Name: MICHELLE JACOMINO
Title: DIRECTOR OF PAYOR RELATIONS
Phone: (770) 916-9000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Dental Anesthesiology — Dental Anesthesiology	1223D0004X
Dentist - Endodontics — Endodontics	1223E0200X
Dentist - Pediatric Dentistry — Pediatric Dentistry	1223P0221X
Dentist - Periodontics — Periodontics	1223P0300X
Dentist - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery	1223S0112X
Dentist - General Practice — General Practice	1223G0001X	Primary

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