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General NPI Number Information
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NPI Number | 1396196812
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Entity Type | Organization
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Legal Business Name | SAVANNAH PERIODONTICS, P.C
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 310 EISENHOWER DR STE 4
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City | SAVANNAH
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State | GA
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Zip | 31406-2632
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Country | US
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Telephone | 912-355-2688
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Fax | 912-355-2657
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Provider Business Mailing Address
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Address Line | 310 EISENHOWER DR STE 4
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City | SAVANNAH
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State | GA
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Zip | 31406-2632
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Country | US
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Telephone | 912-355-2688
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Fax | 912-355-2657
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ELIZABETH J. HENDERSON
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Credential |
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Telephone | 912-355-2688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN013747
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License Number State | GA
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