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General NPI Number Information
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NPI Number | 1649164898
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Entity Type | Organization
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Legal Business Name | ISLAND DENTAL PARTNERS, LLC
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 123 MAIN ST
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City | ST SIMONS ISLAND
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State | GA
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Zip | 31522-1680
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Country | US
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Telephone | 912-638-9921
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Fax | 912-638-4121
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Provider Business Mailing Address
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Address Line | 2487 DEMERE RD STE 100
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City | ST SIMONS ISLAND
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State | GA
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Zip | 31522-5640
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Country | US
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Telephone | 912-638-9921
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | PAUL THOMPSON
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Credential | DMD
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Telephone | 912-638-9921
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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 |
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License Number State |
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