| Monticello Family Dentistry | |
|
458 W Washington St Monticello GA 31064-1368 | |
| (706) 468-6394 | |
| (706) 468-8113 |
| Full Name | Monticello Family Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 458 W Washington St, Monticello, Georgia |
| Authorized Official Name and Position | Tyler Lipham (OWNER/AGENT) |
| Authorized Official Contact | 7064686394 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Monticello Family Dentistry 458 W Washington St Monticello GA 31064-1368 Ph: (706) 468-6394 | Monticello Family Dentistry 458 W Washington St Monticello GA 31064-1368 Ph: (706) 468-6394 |
| NPI Number | 1679340368 |
|---|---|
| Provider Enumeration Date | 12/04/2023 |
| Last Update Date | 12/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679340368 | NPI | - | NPPES |
| 003236116C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |