Basic Information
| Provider Information | |||||||||
| NPI: | 1831328327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDERBURG | ||||||||
| FirstName: | AURELIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 TOM HILL SR BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312101817 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 TOM HILL SR BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312101817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786543111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2009 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223E0200X | DN014507 | GA | Y | Dental Providers | Dentist | Endodontics |
No ID Information.