Individual
TERRENCE L VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1631 GORDON HWY, #22, AUGUSTA, GA 30906-2292
(706) 790-9302
(706) 790-9303
Mailing address
1631 GORDON HWY, #22, AUGUSTA, GA 30906-2292
(706) 790-9302
(706) 790-9303
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
3827
SC
1223G0001X
General Practice Dentistry
Primary
DN012433
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2670243
UNITED CONCORDIA
GA
05
—
747629278A
—
GA
01
—
9180178
DENTAQUEST
GA
05
—
ZX3827
—
SC
Enumeration date
02/18/2006
Last updated
03/26/2015
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