| Les J. Kicklighter, D.m.d., P.c. | |
|
512 Gentilly Rd Statesboro GA 30458-5149 | |
| (912) 489-4151 | |
| Not Available |
| Full Name | Les J. Kicklighter, D.m.d., P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 512 Gentilly Rd, Statesboro, Georgia |
| Authorized Official Name and Position | Les J. Kicklighter (PRESIDENT) |
| Authorized Official Contact | 9124894151 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Les J. Kicklighter, D.m.d., P.c. 512 Gentilly Rd Statesboro GA 30458-5149 Ph: (912) 489-4151 | Les J. Kicklighter, D.m.d., P.c. 512 Gentilly Rd Statesboro GA 30458-5149 Ph: (912) 489-4151 |
| NPI Number | 1053442608 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053442608 | NPI | - | NPPES |
| 00956007A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN012401 (Georgia) | Primary |
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