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General NPI Number Information
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NPI Number | 1568645026
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Entity Type | Individual
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Provider Name | THOMAS EVERATT DUVAL DDS
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Gender | Male
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 06/02/2018
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Provider Practice Location Address
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Address Line | 800 N GLYNN ST
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061
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Country | US
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Telephone | 478-745-3872
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Fax |
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Provider Business Mailing Address
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Address Line | 253 STONE BROOKE DR
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City | GRAY
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State | GA
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Zip | 31032-5888
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Country | US
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Telephone | 478-936-9816
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN008658
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License Number State | GA
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