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General NPI Number Information
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NPI Number | 1548505126
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Entity Type | Organization
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Legal Business Name | HOWARD FAMILY DENTAL - STATESBORO, LLC
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 356 NORTHSIDE DR E
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City | STATESBORO
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State | GA
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Zip | 30458-4839
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Country | US
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Telephone | 912-225-5521
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Fax |
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Provider Business Mailing Address
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Address Line | 356 NORTHSIDE DR E
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City | STATESBORO
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State | GA
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Zip | 30458-4839
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Country | US
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Telephone | 912-225-5521
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | KATHIE ARMSTRONG
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Credential |
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Telephone | 502-254-8501
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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 |
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License Number State |
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