Individual
DR. DAVID NEAL FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1222 GEORGE C WILSON DR, AUGUSTA, GA 30909-4502
(706) 868-9500
(706) 868-5081
Mailing address
1222 GEORGE C WILSON DR, AUGUSTA, GA 30909-4502
(706) 868-9500
(706) 868-5081
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10995
GA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
3369
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00707396B
—
GA
01
—
7561
MEDICARE SC GROUP
SC
01
—
GRP5093
MEDICARE GA GROUP
GA
05
—
Z33697
—
SC
Enumeration date
07/06/2006
Last updated
01/21/2008
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