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NPI Code Detail

MEDICARE: HINESVILLE FAMILY DENTISTRY, P.C.

MEDICARE: HINESVILLE FAMILY DENTISTRY, P.C.
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
1122300000XDentist
21223E0200XEndodontics
31223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1407223126
Entity Type Code : Organization
Provider Name (Legal Business Name) : HINESVILLE FAMILY DENTISTRY, P.C.
Provider Business Mailing Address
First Line : 1090 NORTHCHASE PARKWAY
Second Line : STE 150
City : MARIETTA
State : GA
Zip : 30067
Country : US
Telephone Number : 770-916-5031
Fax Number :
Provider Business Practice Location Address
First Line : 124 W ML KING JR DR
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-3226
Country : US
Telephone Number : 912-816-2155
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : CARLOS MARTINOLAS
Credential : D.D.S.
Telephone Number : 912-816-2155
Provider Enumeration Date : 08/28/2015
Last Update Date : 12/06/2016

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Directions to “HINESVILLE FAMILY DENTISTRY, P.C. ” Practice Location

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