| East Georgia Oral & Maxillofacial Surgery Center | |
|
613 E Grady St Statesboro GA 30458-5104 | |
| (912) 764-5435 | |
| (912) 764-9789 |
| Full Name | East Georgia Oral & Maxillofacial Surgery Center |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 613 E Grady St, Statesboro, Georgia |
| Authorized Official Name and Position | Rodrigo Lorenzo Uribe (OWNER) |
| Authorized Official Contact | 9127645435 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Georgia Oral & Maxillofacial Surgery Center 613 E Grady St Statesboro GA 30458-5104 Ph: (912) 764-5435 | East Georgia Oral & Maxillofacial Surgery Center 613 E Grady St Statesboro GA 30458-5104 Ph: (912) 764-5435 |
| NPI Number | 1184946337 |
|---|---|
| Provider Enumeration Date | 02/15/2010 |
| Last Update Date | 02/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184946337 | NPI | - | NPPES |
| 478841397B | Medicaid | GA | |
| 000514489A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 11060 (Georgia) | Primary |
| 261QD0000X | Clinic/center - Dental | 012756 (Georgia) | Secondary |
Bulloch Oral And Maxillofacial Surgery And Dental Implant Center Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 301 Florence Ave, Statesboro, GA 30458 Phone: 912-764-7500 Fax: 912-764-7503 | |
Les J. Kicklighter, D.m.d., P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 512 Gentilly Rd, Statesboro, GA 30458 Phone: 912-489-4151 | |
Bray, Dmd & Young, Dmd, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2 Lester Ct, Statesboro, GA 30458 Phone: 912-489-1386 Fax: 912-764-8533 | |
East Georgia Center For Oral & Facial Surgery Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1222 Brampton Ave, Statesboro, GA 30458 Phone: 912-764-5435 Fax: 912-764-9789 | |
Jason R. Mcgibony, Dmd Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 378 Savannah Ave, Statesboro, GA 30458 Phone: 912-764-4403 Fax: 912-764-7210 | |
Bulloch Oral And Maxillofacial Surgery And Dental Implant Center Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 301 Florence Ave, Statesboro, GA 30458 Phone: 912-408-7100 |