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General NPI Number Information
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NPI Number | 1881629392
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Entity Type | Organization
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Legal Business Name | SOUTHERN ORAL SURGERY PC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 614 S 8TH ST
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City | GRIFFIN
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State | GA
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Zip | 30224-4214
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Country | US
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Telephone | 770-228-1010
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Fax | 678-692-0242
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Provider Business Mailing Address
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Address Line | 614 S 8TH ST
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City | GRIFFIN
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State | GA
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Zip | 30224-4214
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Country | US
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Telephone | 770-228-1010
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Fax | 678-692-0242
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC D FERRARA
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Credential | DDS
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Telephone | 770-228-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN012761
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN013416
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License Number State | GA
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