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General NPI Number Information
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NPI Number | 1417068164
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Entity Type | Organization
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Legal Business Name | P L HOOTON DMD PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 206 ARNOW DR
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City | SAINT MARYS
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State | GA
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Zip | 31558-4071
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Country | US
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Telephone | 912-882-2005
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Fax | 912-882-2342
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Provider Business Mailing Address
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Address Line | 206 ARNOW DR
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City | SAINT MARYS
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State | GA
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Zip | 31558-4071
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Country | US
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Telephone | 912-882-2005
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Fax | 912-882-2342
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. PHILIP L HOOTON
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Credential | DMD
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Telephone | 912-882-2005
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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 | 11304
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License Number State | GA
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