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General NPI Number Information
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NPI Number | 1679893424
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Entity Type | Organization
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Legal Business Name | MILLEDGEVILLE DENTAL IMAGING, LLC
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 112 WRIGHT DR SUITE E
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-8566
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Country | US
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Telephone | 478-454-2214
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Fax |
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Provider Business Mailing Address
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Address Line | 112 WRIGHT DR SUITE E
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-8566
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Country | US
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Telephone | 478-454-2214
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FRANK SPIVEY ARNOLD
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Credential | D.M.D.
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Telephone | 478-454-2214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 9324
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License Number State | GA
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