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General NPI Number Information
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NPI Number | 1215220579
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Entity Type | Organization
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Legal Business Name | EASTMAN DENTAL ASSOCIATES
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Dates
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Enumeration Date | 05/19/2011
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 501 GRIFFIN AVE
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City | EASTMAN
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State | GA
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Zip | 31023-6712
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Country | US
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Telephone | 478-374-7719
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Fax | 478-374-7044
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Provider Business Mailing Address
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Address Line | P.O. BOX 247
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City | EASTMAN
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State | GA
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Zip | 31023
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Country | US
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Telephone | 478-374-7719
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Fax | 478-374-7044
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CINDY MARIE HENDERSON
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Credential |
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Telephone | 478-374-7719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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