| Providence Dental Llc | |
|
225 N Macon St Macon GA 31210-6562 | |
| (478) 733-0857 | |
| (478) 254-5709 |
| Full Name | Providence Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 225 N Macon St, Macon, Georgia |
| Authorized Official Name and Position | Paul Jason Mann (OWNER) |
| Authorized Official Contact | 4787330857 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Dental Llc 225 N Macon St Macon GA 31210-6562 Ph: (478) 733-0857 | Providence Dental Llc 225 N Macon St Macon GA 31210-6562 Ph: (478) 733-0857 |
| NPI Number | 1295189595 |
|---|---|
| Provider Enumeration Date | 04/22/2016 |
| Last Update Date | 07/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295189595 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN013536 (Georgia) | Primary |
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