Pine Mountain Family Dentistry, Llc | |
8944 Hamilton Road Pine Mountain GA 31822 | |
(706) 663-2272 | |
(706) 663-2075 |
Full Name | Pine Mountain Family Dentistry, Llc |
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Speciality | Dentist |
Location | 8944 Hamilton Road, Pine Mountain, Georgia |
Authorized Official Name and Position | Sidney Dauster Harden (DENTIST) |
Authorized Official Contact | 7066632272 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Pine Mountain Family Dentistry, Llc P.o. Box 1176 Pine Mountain GA 31822-4707 Ph: (706) 663-2272 | Pine Mountain Family Dentistry, Llc 8944 Hamilton Road Pine Mountain GA 31822 Ph: (706) 663-2272 |
NPI Number | 1780915165 |
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Provider Enumeration Date | 01/25/2010 |
Last Update Date | 01/25/2010 |
Identifier | Type | State | Issuer |
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1780915165 | NPI | - | NPPES |
000045295A | Medicaid | GA | |
594312970B | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | DNO12733 (Georgia) | Primary |
122300000X | Dentist | DNO08005 (Georgia) | Secondary |