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618 N Houston Lake Blvd Centerville GA 31028-1010 | |
(478) 956-6520 | |
Not Available |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 618 N Houston Lake Blvd, Centerville, Georgia |
Authorized Official Name and Position | Denise Patrick Noel (DENTISIT) |
Authorized Official Contact | 4789536520 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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618 N Houston Lake Blvd Centerville GA 31028 Ph: (478) 956-6520 | 618 N Houston Lake Blvd Centerville GA 31028-1010 Ph: (478) 956-6520 |
NPI Number | 1255640082 |
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Provider Enumeration Date | 09/28/2010 |
Last Update Date | 09/28/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255640082 | NPI | - | NPPES |
979736219A | Medicaid | GA | |
1982750766 | Other | GA | INDIVIDUAL NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 10704 (Georgia) | Primary |