Organization
ELEMENT DENTAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JACOMINO-BARNES (DIRECTOR CREDENTIALING & ENROLLMENT)
(813) 270-9497
Entity
Organization
Contact information
Practice address
3456 WRIGHTSBORO RD, AUGUSTA, GA 30909-2678
(706) 251-7917
Mailing address
PO BOX 70887, CLEVELAND, OH 44190-0887
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/13/2023
Last updated
09/14/2023
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