| Eaglin Dental Group, Fayetteville | |
|
692 Glynn St N Ste S Fayetteville GA 30214-6705 | |
| (770) 716-2701 | |
| (770) 716-2718 |
| Full Name | Eaglin Dental Group, Fayetteville |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 692 Glynn St N Ste S, Fayetteville, Georgia |
| Authorized Official Name and Position | Tracie Denney (OWNER) |
| Authorized Official Contact | 7707162701 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eaglin Dental Group, Fayetteville 692 Glynn St N Ste S Fayetteville GA 30214-6705 Ph: (770) 716-2701 | Eaglin Dental Group, Fayetteville 692 Glynn St N Ste S Fayetteville GA 30214-6705 Ph: (770) 716-2701 |
| NPI Number | 1134405848 |
|---|---|
| Provider Enumeration Date | 10/26/2011 |
| Last Update Date | 05/10/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134405848 | NPI | - | NPPES |
| 777472578D | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN013169 (Georgia) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | DN013169 (Georgia) | Secondary |
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