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General NPI Number Information
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NPI Number | 1669805503
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Entity Type | Organization
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Legal Business Name | KIDS ZONE DENTISTRY & LAGRANGE FAMILY DENTAL
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Dates
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Enumeration Date | 08/14/2013
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 307 CHURCH ST STE A
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City | LAGRANGE
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State | GA
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Zip | 30240-2700
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Country | US
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Telephone | 706-882-0591
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Fax | 706-845-9546
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Provider Business Mailing Address
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Address Line | 307 CHURCH ST STE A
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City | LAGRANGE
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State | GA
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Zip | 30240-2700
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Country | US
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Telephone | 706-882-0591
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Fax | 706-845-9546
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHUCK PITTS
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Credential | D.M.D
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Telephone | 706-882-0591
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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 | DN009828
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License Number State | GA
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