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General NPI Number Information
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NPI Number | 1457759508
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Entity Type | Organization
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Legal Business Name | FAMILY DENTISTRY OF DUBLIN, P.C.
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 2400 BELLEVUE RD #24
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City | DUBLIN
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State | GA
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Zip | 31021-2885
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Country | US
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Telephone | 770-916-5031
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Fax |
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Provider Business Mailing Address
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Address Line | 1090 NORTHCHASE PKWY SE SUITE 150
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City | MARIETTA
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State | GA
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Zip | 30067-6405
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Country | US
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Telephone | 770-916-5031
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILLIP DERRICK HAMPTON
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Credential | D.M.D.
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Telephone | 770-916-5031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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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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Taxonomy #3
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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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