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General NPI Number Information
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NPI Number | 1417174723
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Entity Type | Organization
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Legal Business Name | MIDDLE GEORGIA FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 2400 BELLEVUE RD STE 28
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City | DUBLIN
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State | GA
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Zip | 31021-2874
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Country | US
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Telephone | 478-272-1933
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Fax | 478-275-7973
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Provider Business Mailing Address
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Address Line | 2400 BELLEVUE RD STE 28
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City | DUBLIN
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State | GA
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Zip | 31021-2874
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Country | US
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Telephone | 478-272-1933
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Fax | 478-275-7973
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Authorized Official
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Title or Position | MANAGER
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Name | LEE D ALLEN
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Credential |
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Telephone | 478-272-1933
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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 | 11329
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 012354
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License Number State | GA
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