Vandiver, Terrence L
Vandiver, Terrence L is an individual health care provider with primary practice located at 1631 Gordon Hwy #22, Augusta GA 30906-2292. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Vandiver, Terrence L can be contacted via phone (706) 790-9302.Contact Information
Primary practice address
1631 Gordon Hwy #22
Augusta GA 30906-2292
Phone: (706) 790-9302
Fax: (706) 790-9303
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | DN012433 | Georgia |
| Dental Providers / General Practice | 1223G0001X | 3827 | South Carolina |
Profile Details
| NPI number | 1306811914 |
|---|---|
| LBN Legal business name | Vandiver, Terrence L |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 18th, 2006 |
| Last updated | Mar 26th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306811914 | NPPES |
| South Carolina | MEDICAID | ZX3827 | |
| South Carolina | MEDICAID | 747629278A | |
| South Carolina | Other | 9180178 | |
| South Carolina | Other | 2670243 |
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