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General NPI Number Information
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NPI Number | 1760841217
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Entity Type | Organization
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Legal Business Name | OGLETHORPE FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 615 W OGLETHORPE HWY
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City | HINESVILLE
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State | GA
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Zip | 31313-4485
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Country | US
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Telephone | 912-877-3070
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Fax | 912-877-3082
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Provider Business Mailing Address
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Address Line | PO BOX 408
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City | HINESVILLE
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State | GA
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Zip | 31310-0408
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Country | US
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Telephone | 912-877-3070
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Fax | 912-877-3082
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOYCE M ROBERTS
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Credential | DMD
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Telephone | 912-877-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN013949
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License Number State | GA
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