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General NPI Number Information
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NPI Number | 1720999808
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Entity Type | Organization
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Legal Business Name | GEORGIA DENTAL GROUP-LAGRANGE PC
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 313 MOOTY BRIDGE RD
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City | LAGRANGE
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State | GA
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Zip | 30240-1809
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Country | US
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Telephone | 706-365-0016
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Fax |
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Provider Business Mailing Address
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Address Line | 134 PROFESSIONAL WAY
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City | BALDWIN
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State | GA
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Zip | 30511-4000
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Country | US
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Telephone | 913-961-1270
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Fax |
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Authorized Official
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Title or Position | COO
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Name | CHRISTOPHER ZACHAREWICZ
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Credential |
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Telephone | 913-961-1270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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