Healthcare Provider Details

I. General information

NPI: 1457759508
Provider Name (Legal Business Name): FAMILY DENTISTRY OF DUBLIN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BELLEVUE RD #24
DUBLIN GA
31021-2885
US

IV. Provider business mailing address

1090 NORTHCHASE PKWY SE SUITE 150
MARIETTA GA
30067-6405
US

V. Phone/Fax

Practice location:
  • Phone: 770-916-5031
  • Fax:
Mailing address:
  • Phone: 770-916-5031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP DERRICK HAMPTON
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 770-916-5031