| Idealsmile | |
|
2501 Whittlesey Blvd Suite B Columbus GA 31909-3031 | |
| (706) 257-7374 | |
| (706) 257-7379 |
| Full Name | Idealsmile |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2501 Whittlesey Blvd, Columbus, Georgia |
| Authorized Official Name and Position | Jae H Ham (PRESIDENT) |
| Authorized Official Contact | 7062577374 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idealsmile 2501 Whittlesey Blvd Suite B Columbus GA 31909-3031 Ph: (706) 257-7374 | Idealsmile 2501 Whittlesey Blvd Suite B Columbus GA 31909-3031 Ph: (706) 257-7374 |
| NPI Number | 1710130455 |
|---|---|
| Provider Enumeration Date | 10/28/2008 |
| Last Update Date | 10/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710130455 | NPI | - | NPPES |
| 561235509C | Medicaid | GA | |
| 626075029C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN013040 (Georgia) | Primary |
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Georgia Dental Alliance Of Columbus Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6410 W Hamilton Park Dr, Columbus, GA 31909 Phone: 706-653-8700 | |
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Vbdc Of Columbus Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5448 Whittlesey Blvd Ste B, Columbus, GA 31909 Phone: 478-733-0857 Fax: 478-254-5709 | |