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General NPI Number Information
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NPI Number | 1598140600
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Entity Type | Organization
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Legal Business Name | GOLDEN ISLES PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 2475 VILLAGE DR SUITE 114
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City | KINGSLAND
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State | GA
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Zip | 31548-6728
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Country | US
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Telephone | 912-882-4040
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Fax | 912-882-3514
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Provider Business Mailing Address
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Address Line | 2475 VILLAGE DR SUITE 114
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City | KINGSLAND
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State | GA
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Zip | 31548-6728
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Country | US
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Telephone | 912-882-4040
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Fax | 912-882-3514
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. PATRICIA DUNN
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Credential | D.D.S.
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Telephone | 912-882-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN012985
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License Number State | GA
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