MEDICARE: COMPASSIONATE MOBILE DENTISTS OF GEORGIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN013080	GA

General Provider Information

NPI Number	:	1134543515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE MOBILE DENTISTS OF GEORGIA

Provider Business Mailing Address
First Line	:	PO BOX 27328
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31221-7328
Country	:	US
Telephone Number	:	478-952-7522
Fax Number	:

Provider Business Practice Location Address
First Line	:	3907 UPPER RIVER RD
Second Line	:
City	:	GRAY
State	:	GA
Zip	:	31032-3821
Country	:	US
Telephone Number	:	478-952-7522
Fax Number	:

Authorized Official
Title or Position	:	CMO
Name	:	MARGARET G MOORE
Credential	:	DMD
Telephone Number	:	478-952-7522

Provider Enumeration Date	:	02/06/2014
Last Update Date	:	02/06/2014

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Directions to “COMPASSIONATE MOBILE DENTISTS OF GEORGIA ” Practice Location

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