Healthcare Provider Details

I. General information

NPI: 1679712574
Provider Name (Legal Business Name): GARDEN CITY DENTURE AND DENTAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 AUGUSTA RD STE. 106
GARDEN CITY GA
31408-2121
US

IV. Provider business mailing address

4019 AUGUSTA RD STE. 106
GARDEN CITY GA
31408-2121
US

V. Phone/Fax

Practice location:
  • Phone: 912-966-5489
  • Fax: 912-966-5949
Mailing address:
  • Phone: 912-966-5489
  • Fax: 912-966-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN009844
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN011961
License Number StateGA

VIII. Authorized Official

Name: RICHARD S. MARSH
Title or Position: MANAGING MEMBER/DENTIST
Credential: DMD
Phone: 912-966-5489