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>> Dentist >> Dental Providers

Registrant NPI Number: 1619955895

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 706-787-6927  Fax: 706-787-2082

Contact information for business:
Tel: 706-787-6927  Fax: 706-787-2082

Registration Information:
NPI: 1619955895
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
X122300000XDental Providers
X1223E0200XDental Providers

Legacy codes, insurance codes and state license numbers:



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