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General NPI Number Information
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NPI Number | 1902017270
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Entity Type | Organization
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Legal Business Name | PEACH FAMILY DENTISTRY,LLC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 302 KNOXVILLE ST
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City | FORT VALLEY
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State | GA
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Zip | 31030-4251
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Country | US
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Telephone | 478-825-3315
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Fax | 478-825-8396
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Provider Business Mailing Address
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Address Line | 302 KNOXVILLE ST
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City | FORT VALLEY
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State | GA
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Zip | 31030-4251
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Country | US
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Telephone | 478-825-3315
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Fax | 478-825-8396
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAWSON KENDRICK MATHEWS
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Credential | D.M.D.
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Telephone | 478-825-3315
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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 | DN008283
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License Number State | GA
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