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General NPI Number Information
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NPI Number | 1023171287
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Entity Type | Organization
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Legal Business Name | WAYNE S. MARIS, DDS, PC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 171 PERRY HOUSE RD PO DRAWER 1009
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City | FITZGERALD
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State | GA
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Zip | 31750-8837
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Country | US
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Telephone | 229-423-9237
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Fax |
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Provider Business Mailing Address
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Address Line | 171 PERRY HOUSE RD PO DRAWER 1009
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City | FITZGERALD
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State | GA
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Zip | 31750-8837
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Country | US
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Telephone | 229-423-9237
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WAYNE MARIS
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Credential |
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Telephone | 229-423-9237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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