Healthcare Provider Details

I. General information

NPI: 1023171287
Provider Name (Legal Business Name): WAYNE S. MARIS, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 PERRY HOUSE RD PO DRAWER 1009
FITZGERALD GA
31750-8837
US

IV. Provider business mailing address

171 PERRY HOUSE RD PO DRAWER 1009
FITZGERALD GA
31750-8837
US

V. Phone/Fax

Practice location:
  • Phone: 229-423-9237
  • Fax:
Mailing address:
  • Phone: 229-423-9237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: WAYNE MARIS
Title or Position: OWNER
Credential:
Phone: 229-423-9237