Provider Demographics
NPI:1144358649
Name:DARDEN, JEREMY PATE (DMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:PATE
Last Name:DARDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 W 3RD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3647
Mailing Address - Country:US
Mailing Address - Phone:229-439-7008
Mailing Address - Fax:229-439-7660
Practice Address - Street 1:1503 W 3RD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3647
Practice Address - Country:US
Practice Address - Phone:229-439-7008
Practice Address - Fax:229-439-7660
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist