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General NPI Number Information
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NPI Number | 1316184575
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Entity Type | Individual
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Provider Name | DAVID S. DORITY D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 10015 FORD AVE 2-A ST. JOSEPH MEDICAL PLAZA
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City | RICHMOND HILL
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State | GA
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Zip | 31324-8804
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Country | US
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Telephone | 912-756-3880
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Fax | 912-756-3516
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Provider Business Mailing Address
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Address Line | 10015 FORD AVE 2-A ST. JOSEPH MEDICAL PLAZA
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City | RICHMOND HILL
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State | GA
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Zip | 31324-8804
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Country | US
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Telephone | 912-756-3880
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Fax | 912-756-3516
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 012438
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License Number State | GA
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