Healthcare Provider Details

I. General information

NPI: 1992616486
Provider Name (Legal Business Name): EASTMAN FAMILY DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 OAK ST
EASTMAN GA
31023-6027
US

IV. Provider business mailing address

2557 MCPHERSON CHURCH RD
DALLAS GA
30132-7139
US

V. Phone/Fax

Practice location:
  • Phone: 478-242-6965
  • Fax:
Mailing address:
  • Phone: 913-961-1270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER ZACHAREWICZ
Title or Position: COO
Credential:
Phone: 913-961-1270