Healthcare Provider Details

I. General information

NPI: 1932126836
Provider Name (Legal Business Name): FILLING STATION FAMILY DENTAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 E BROAD AVE
ALBANY GA
31705-2611
US

IV. Provider business mailing address

PO BOX 3821
ALBANY GA
31706-3821
US

V. Phone/Fax

Practice location:
  • Phone: 229-435-5176
  • Fax: 229-435-0417
Mailing address:
  • Phone: 229-435-5176
  • Fax: 229-435-0417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9325
License Number StateGA

VIII. Authorized Official

Name: DR. RONNIE WILLIAM ARRINGTON
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 229-435-5176