Healthcare Provider Details

I. General information

NPI: 1760966295
Provider Name (Legal Business Name): 310HABERSHAMDENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EISENHOWER DR BUILDING 1
SAVANNAH GA
31406
US

IV. Provider business mailing address

310 EISENHOWER DR BUILDING 1
SAVANNAH GA
31406
US

V. Phone/Fax

Practice location:
  • Phone: 912-234-2206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER ALLEN
Title or Position: MANAGER
Credential:
Phone: 912-234-2206