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General NPI Number Information
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NPI Number | 1518353846
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Entity Type | Organization
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Legal Business Name | MARK A. ROLAND, DMD PC
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 101 E NORTHSIDE DR SUITE D
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City | VALDOSTA
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State | GA
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Zip | 31602-1724
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Country | US
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Telephone | 229-244-0944
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Fax | 229-244-0965
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Provider Business Mailing Address
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Address Line | 101 E NORTHSIDE DR SUITE D
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City | VALDOSTA
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State | GA
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Zip | 31602-1724
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Country | US
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Telephone | 229-244-0944
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Fax | 229-244-0965
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK A ROLAND
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Credential | DMD
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Telephone | 229-244-0944
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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 | DN013748
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License Number State | GA
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