MEDICARE: DR. DEBBIE L DISMUKE

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	DN010213	GA

General Provider Information

NPI Number	:	1336254275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBBIE L DISMUKE

Provider Business Mailing Address
First Line	:	PO BOX 1266
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31534-1266
Country	:	US
Telephone Number	:	912-384-2277
Fax Number	:	912-384-7543

Provider Business Practice Location Address
First Line	:	1305 OCILLA RD
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-2209
Country	:	US
Telephone Number	:	912-384-2277
Fax Number	:	912-384-7543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	03/27/2008

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