Healthcare Provider Details

I. General information

NPI: 1154130904
Provider Name (Legal Business Name): TOCCOA FAMILY DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BIG A RD
TOCCOA GA
30577-6030
US

IV. Provider business mailing address

1301 BIG A RD
TOCCOA GA
30577-6030
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-7433
  • Fax:
Mailing address:
  • Phone: 706-886-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CASEY CASTLE
Title or Position: DIRECTOR OF PAYOR CONTRACTING
Credential:
Phone: 912-732-1504